Complications
Pulmonary contusions will usually resolve in 3 to 5 days, provided no secondary insult occurs. The main complications of pulmonary contusion are ARDS and pneumonia. Approximately 50% of patients with pulmonary contusion develop ARDS, and 80% of patients with pulmonary contusions involving over 20% of lung volume. Direct lung trauma, alveolar hypoxia and blood in the alveolar spaces are all major activators of the inflammatory pathways that result in acute lung injury.
Pneumonia is also a common complication of pulmonary contusion, blood in the alveolar spaces providing an excellent culture medium for bacteria. Clearance of secretions is decreased with pulmonary contusion, and this is augmented by any chest wall injury and mechanical ventilation. Good tracheal toilet and pulmonary care is essential to minimise the incidence of pneumonia in this susceptible group.