The Influence of Traumatic Injuries Early Diagnosis on the Development of Pulmonary Complications in Patients With Multisystem Chest Trauma

Despite the existing progress in providing care to patients with severe multisystem chest injury using advanced diagnostic methods, a high mortality rate still reaches 20–30%.

Aim of study. To assess the impact of early diagnosis and correction of chest injuries on the development of complications in patients with multisystem trauma.

Material and methods. The results of diagnosis and treatment of 89 patients with severe multisystem closed chest injury were studied. According to the time of admission to the Institute, the patients were divided into two groups: Group I, who were admitted to the Institute within the first hours after the injury (51 patients), and Group II, who were transferred from other medical institutions on the 3rd–7th day (38). CT was performed as a standard method of diagnosis and monitoring the dynamics of the process. With the development of purulent-inflammatory pulmonary complications, the bacteriological test of bronchoalveolar lavage was performed. Treatment included complex intensive therapy, drainage of the pleural cavity and emergency surgical interventions, if necessary.

Results. In Group I, lung contusion occurred in 43 (84%) patients, and after 7-10 days, the contusion foci partially regressed in 20 (46.5%) patients. In 8 (16%) patients with lung rupture, infiltrative changes in the lung were resolved on the 18th-30th day, while 4 (50%) of them had pneumonia outside the contusion zones. In Group II, patients were put on a ventilator and inflammatory changes in the lungs were revealed in 30 patients (79%). Lung rupture associated with the contusion was revealed in 2 (5.2%). When comparing the groups by the composition of the isolated microflora, it was found that in patients of group II, Acinetobacter spp was more often found (46.7% vs. 17.1% in group I patients, p=0.021) and Enterococcus spp. (30.0% and 8.6%, respectively, p=0.058), as well as Klebsiella pneumoniae (46.7% and 37.1%, p=0.6). At the same time, Staphylococcus aureus was not found in these patients, while it was detected in 14.3% of patients from Group I (p=0.09). Medical care in Group I was carried out according to the principles of the “golden hour”: within the first hour from the moment of admission to the patients with the presence of pneumothorax and hemothorax, the pleural cavity was drained. In Group II, this procedure was performed in other medical institutions and in 5 additional patients at the Institute.

Conclusions. Early computed tomography diagnosis of multisystem trauma makes it possible to assess the severity of injuries to the chest organs and other areas of the body and determine the treatment tactics. A comprehensive approach to the management of patients, including early diagnosis of trauma, drainage of the pleural cavity, determination of management tactics, bacterial test of the lower respiratory tract discharge, helps reduce infectious complications by an average of 45.46%. 

1. Kochergaev OV. Raspoznavanie povrezhdeniy legkikh pri sochetannoy travme grudi. Khirurgiya. 2002;(10):18–23 (in Russ.).

2. Radiology in Urgent Medicine. Russian Sklifosovsky Journal Emergency Medical Care. 2017;6(1):8–12. (in Russ.)

3. Samokhvalov IM, Gavrilin SV, Suprun AYu, Meshakov DP, Nedomolkin SV, Khrapov KN. Implication of Pulmonary Contusion in the Pathogenesis of Respiratory Disorders in Severe Concomitant Chest Trauma. Messenger of Anesthesiology and Resuscitation. 2011;8(5):11–16. (in Russ.)

4. Kuzin AA, Suborova TN, Ogarkov PI, Samokhvalov IM, Boyarintsev VV, Gavrilin SV, et al. Etiologicheskaya struktura i puti uluchsheniya profilaktiki infektsionnykh oslozhneniy u patsientov s politravmoy. Infektsiya v khirurgii. 2010;8(2):39–43.

5. Lang P, Kulla M, Kerwagen F, Lefering R, Friemert B, Palm H-G, et al. The role of whole-body computed tomography in the diagnosis of thoracic injuries in severely injured patients – a retrospective multicenter study based on the trauma registry of the German trauma society (Trauma Register DGU). Scand J Trauma Resusc Emerg. Med. 2017;25(1):82. PMID: 28810921 https://doi.org/10.1186/s13049-017-0427-4

6. Peters S, Nicolas V, Heyer CN. Multidetector computed tomographyspectrum of blunt chest wall and lung injuries in politraumatizm patient. Clin Radiol. 2010;65(4):333–338. PMID: 20338402 https://doi.org/10.1016/j.crad.2009.12.008

7. Bagdasarov VV, Garkavi AV, Bagdasarova EA, Ramishvili VSh, Protsenko DN, Guzoeva LA. Optimizatsiya taktiki lecheniya pri zakrytoy sochetannoy travme grudi. Russian Journal of Surgery. 2011;(2):13–19. (in Russ.)

8. Bayer J, Lefering R, Reinhardt S, Kuhle J, Sudkamp NP, Hammer T. Severity dependent differences in early management of thoracic trauma inseverely injured patients analysis based on the Trauma Register DGU®. Scand J Trauma Resusc Emerg. Med. 2017;25(1):10. PMID: 28148274 https://doi.org/10.1186/s13049-017-0354-4

9. Dewar DC, Tarrant SM, King KL, Balogh ZJ. Changes in the epidemiology and prediction of multipleorgan failure after injury. J Trauma Acute Care Surg. 2013;74(3):774–779. PMID: 23425734 https://doi.org/10.1097/TA.0b013e31827a6e69

10. Huber S, Biberthaler P, Delhey P, Trentzsch H, Winter H, van Griensven M, et al. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®). Scand J Trauma Resusc Emerg Med. 2014;22:52. PMID: 25204466 https://doi.org/10.1186/s13049-014- 0052-4

11. Horst К, Andruszkow H, Weber CD, Pishnamaz M, Herren C, Zhi Q, et al. Thoracic trauma now and then: A 10 year experience from 16,773 severely injured Patients. PLoS One. 2017;12(10):e0186712. PMID: 29049422 https://doi.org/10.1371/journal.pone.0186712

12. Wu J, Sheng L, Ma Y, Gu J, Zhang M, Gan J, et al. The analysis of risk factors of impacting mortality rate in severe multiple trauma patients with post-traumatic acute respiratory distress syndrome. Am J Emerg Med. 2008;26(4):419–424. PMID: 18410809 https://doi.org/10.1016/j.ajem.2007.06.032

13. Kassil’ VL, Zolotokrylina ES. Ostryy respiratornyy disstress sindrom. Moscow: Meditsina Publ.; 2003. (in Russ.)

14. Artigas AT, Dronda SB, Vallés EC, Marco JM, Usón V, Figueras P, et al. Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med. 2001;29(2):304–309. PMID: 11246310 https://doi.org/10.1097/00003246-200102000-00015

15. Trupka A, Nast-Kolb D, Schweiberer L. Thoracic trauma. Unfallchirurg. с1998;101(4):244–258. PMID: 9613209 https://doi.org/10.1007/s001130050265

16. Miller PR, Croce MA, Kilgo PD, Scott J, Fabian TC. Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg. 2002;68(10):845–850. PMID: 12412708

17. Gumanenko EG, Kozlov VK (eds.). Politravma: travmaticheskaya bolezn’, disfunktsiya immunnoy sistemy, sovremennaya strategiya lecheniya. Moscow: GEOTAR – Media Publ.; 2008. (in Russ.)

18. Antonelli M, Moro ML, Capelli O, De Blasi RA, D’Errico RR, Conti G, et al. Risk factors for early onset pneumonia in trauma patients. Chest. 1994;105(1):224–228. PMID: 8275735. https://doi.org/10.1378/chest.105.1.224

19. Papia G, McLellan BA, El-Helou P, Louie M, Rachlis A, Szalai JP, et al. Infection in hospitalized trauma patients: incidence, risk actors, and complications. J Trauma. 1999;47(5):923–927. PMID: 10568723 https://doi.org/10.1097/00005373-199911000-00018

20. Traub M, Stevenson M, McEvoy S, Briggs G, Lo SK, Leibman S, et al. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury. 2007;38(1):43–47. PMID: 17045268 https://doi.org/10.1016/j.injury.2006.07.006

21. Harris T, Davenport R, Hurst T, Jones J. Improving outcome in severe trauma: trauma systems and initial management: intubation, ventilation and resuscitation. Postgrad Med J. 2012;88(1044):588–594. PMID: 23014941 https://doi.org/10.1136/postgradmedj-2010-74245

22. Bakowitz M, Bruns B, McCunn M. Acute lung injury and the acute respiratory distress syndrome in the injured patient. Scand J Trauma Resusc Emerg Med. 2012;20:54. PMID: 22883052 https://doi. org/10.1186/1757-7241-20-54

23. Gumanenko EK, Ogarkov PI, Lebedev VF, Boyarintsev VV, Kuzin AA. Infectious Complications of Polytraumas: Microbiological and Epidemiological Aspects. Grekov’s Bulletin of Surgery. 2006;165(5):56– 62. (in Russ.)

24. Shabanov AK, Bulava GV, Kisluchina EV, Khubutia MSh. Criteria of High Risk Infection Pulmonary Complications in Severe Polytrauma Patients. Russian Journal of Anaesthesiology and Reanimatology. 2015;60(2):16– 20. (in Russ.)

25. Popova IE, Sharifullin FA, Abakumov MM, Danieljan ShN, Saprin AA. CT in diagnostics of lungs injure in patients with closed thoracic trauma. Journal Diagnostic & Interventional Radiology. 2011; 5(3); 31–35. (in Russ.)