Operative Management of Lung Injuries

Authors: David H Livingston

Publish Date: 2015/09/15

Volume: 1, Issue: 4, Pages: 219-224

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Abstract

The need for operative management of pulmonary injury is uncommon However delaying patients requiring a thoracotomy for trauma increases morbidity and mortality thus the key aspect in management in this patient population is timely an operative intervention Once the decision is made to perform a thoracotomy the goal is to obtain control of hemorrhage as soon as possible Lung lacerations from penetrating trauma usually have a tract though the pulmonary parenchyma and are usually amenable to lungsparing techniques such as tractotomy or limited resections Injuries from blunt trauma usually result in more significant tearing of the lung and are more likely to require larger resections With modern approach to resuscitation it is more important to quickly control hemorrhage than to worry about removing “too much lung” Damage control techniques including temporary hilar clamping and chest packing are useful adjuncts to achieve survivorship in those patients with extensive chest traumaThoracic injuries have been featured prominently in history as far back as the Edwin Smith papyrus in 3000 BC In that document eight of the 43 cases involve chest injuries mostly describing “wounds and breaks of the breast” The insurmountable problem of lung collapse and difficulty in ventilation associated with an open wound of the chest meant that any progress in aggressive or operative management of chest and pulmonary injuries had to wait until the medical advances of the late nineteenth and early twentieth centuries 1This is why almost all of the pretwentieth century operative approaches that were described were for the treatment of empyema when the lung was adherent to the chest wall and would not collapse following drainage While the first thoracotomy for trauma does not seem to be recorded it took combination of the modern endotracheal anesthesia and development of positive pressure ventilation at the beginning of the twentieth century to make thoracotomy for trauma a viable option with acceptable mortality The approach using formal thoracotomy positive pressure ventilation and nitrous/oxygen anesthesia was put into practice by the allies in WWI with marked reduction in mortality and has continued to evolve over the next century 2

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