Pulmonary changes in cranio-cerebral injuries and respiration with high oxygen concentrations

Abstract

In 131 cases of craniocerebral trauma it was shown in what respect definite changes in the lungs, demonstrated by clinical course, radiographs and blood gas analyses, occurred in proportion to the severity of the trauma. The causes of these changes were considered and the possibility of complicating the course of the illness by administering oxygen in high concentrations was investigated. In 98 patients was an indication for treatment with a respirator. 41 patients were so treated for longer than 5 days (mean 17.7 days). The need for respirator treatment rose with the increasing severity of the trauma. Frequency and severity of tracheobronchial aspiration increased in proportion to the depth of unconsciousness. It occurred in 50-60% of cases with severe trauma. Minor pulmonary lesions developed in 13% of those patients who only had minor disturbances of consciousness. Patients who had aspirated had lower arterial oxygen tensions than those who had not aspirated. In a high percentage of cases considerable improvement could be achieved, despite lung changes. In patients treated with the respirator mean inspiratory oxygen concentrations of 75% were necessary to achieve arterial oxygen tensions of 150-200 mm Hg. No evidence of oxygen toxicity was found, despite long periods of treatment with high oxygen concentrations. Very often cases of craniocerebral injury are followed both by tracheobronchial aspiration, causing lung damage, hypoxia and acidosis, and by disturbances of coagulation. These disorders are to be considered as most important, each needing specific therapy.