Update on Mechanical Ventilation in Chest Trauma

Abstract

Chest trauma results from both blunt and penetrating mechanisms of injury. Penetra ting injuries include stab or gunshot wounds as well as impalement. Blunt injuries result from falls, motor vehicle or motorcycle crashes, pedestrian/vehicle collisions, explosions, and other blunt force mechanisms Chest trauma can affect structures inside thoracic cavity as tracheobronchial tree, pleural space, heart, major vessles and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume based resuscitation end points, positioning therapy, and pain management. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies.