Management
Managment of pulmonary contusion is supportive while the pulmonary contusion resolves. Most contusions will require no specific therapy. However large contusions may affect gas exchange and result in hypoxaemia. As the physiological impact of the ocntusions tends to develop over 24-48 hours, close monitoring is required and supplemental oxygen should be administered.
Many of these patients will also have a significant chest wall injury, pain from which will affect their ability to ventilate and to clear secretions. Management of a blunt chest injury therefore includes adequate and appropriate analgesia. Tracheal intubation and mechanical ventilation may be necessary if there is difficulty in oxygenation or ventilation. Usually ventilatory support can be discontinued once the pulmonary contusion has resolved, irrespective of the chest wall injury.
The classic management of pulmonary contusion includes fluid restriction. Much of the data to support this comes from animal models of isolated pulmonary contusion. However, while relative fluid excess and pulmonary oedema will augment any respiratory insufficience, the consequences of the opposite - hypovolaemia are more severe and long-lasting. Prolonged episode of hypoperfusion in trauma patients will result in inflammatory activation and acute lung injury, and may result in ARDS and multiple organ failure. Hence the goal for management of patients with pulmonary contusion should be euvolaemia.