Prevalencia, diagnóstico y tratamiento de las lesiones pulmonares traumáticas

Autores/as

  • Patrizio Petrone NYU Winthrop Hospital
  • Adriana Ruano Campos NYU Winthrop Hospital
  • Amir Gendy NYU Winthrop Hospital
  • Collin E.M. Brathwaite NYU Winthrop Hospital
  • D´ Andrea K. Joseph NYU Winthrop Hospital

DOI:

https://doi.org/10.30944/20117582.107

Palabras clave:

lesión pulmonar; heridas y lesiones; epidemiología; diagnóstico; tratamiento de urgencia; tera- péutica; cirugía.

Resumen

La lesión pulmonar es relativamente infrecuente en el paciente politraumatizado y, posiblemente, subdiagnos- ticada inicialmente debido a su habitual asociación con otras lesiones aparentemente más graves, en particular tras el traumatismo cerrado. Por ello, es de vital importancia su diagnóstico precoz ya que puede conllevar con- secuencias fatales si no se diagnostica a tiempo.

Dada su localización anatómica, es habitual que se acompañe de lesiones concomitantes de otros órganos y estructuras vasculares intratorácicas, lo cual, unido a la necesidad ocasional de maniobras quirúrgicas críticas, resulta en altas tasas de morbimortalidad.
El objetivo del trabajo fue estudiar las características de estas lesiones, incluyendo su incidencia, su mecanismo, y las técnicas diagnósticas y opciones terapéuticas disponibles, tanto quirúrgicas como no quirúrgicas. Además, se analizaron la evolución y el pronóstico de estos pacientes, con base en una revisión bibliográfica de 1965 hasta 2018.

Fecha de recibido: 16/10/2018 – Fecha aceptación: 15/11/2018

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

Patrizio Petrone, NYU Winthrop Hospital

Director of Surgical Research, Department of Surgery, Associate Professor of Surgery, NYU Winthrop Hospital, Mineola, NY, USA

Adriana Ruano Campos, NYU Winthrop Hospital

Division of Trauma and Acute Care Surgery, Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA

Amir Gendy, NYU Winthrop Hospital

Division of Trauma and Acute Care Surgery, Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA

Collin E.M. Brathwaite, NYU Winthrop Hospital

Chairman, Department of Surgery, Associate Professor of Surgery, NYU Winthrop Hospital, Mineola, NY, USA

D´ Andrea K. Joseph, NYU Winthrop Hospital

Chief, Division of Trauma and Acute Care Surgery, Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA

Referencias bibliográficas

Miele V, Buquicchio GL, Piccolo CL, Stasolla A, Gal- luzzo M. Lung injury. In: Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S, editors. Emergen- cy radiology of the chest and the cardiovascular sys- tem. Basel, Switzerland: Springer; 2016. p. 3-121. doi: 10.1007/174_2016_51

https://doi.org/10.1007/174_2016_51

Požgain Z, Kristek D, Lovrić I, Kondža G, Jelavić M, Kocur J, et al. Pulmonary contusions after blunt chest trauma: Clinical significance and evaluation of patient management. Eur J Trauma Emerg Surg. 2018;44:773-7. doi: 10.1007/s00068-017-0876-5

https://doi.org/10.1007/s00068-017-0876-5

Ganie FA, Lone H, Lone GN, Wani ML, Singh S, Dar AM, et al. Lung contusion: A clinico-pathological entity with unpredictable clinical course. Bull Emerg Trau- ma. 2013;1:7-16.

https://doi.org/10.4103/2320-8775.123208

Miller DL, Mansour KA. Blunt traumatic lung injuries. Thorac Surg Clin. 2007;17:57-61.

https://doi.org/10.1016/j.thorsurg.2007.03.017

Asensio JA, Petrone P, Pérez-Alonso A, Templin T, Shetty S, Pust GD, et al. Operative management of pulmonary injuries: Lung-sparing and formal resections. In: Asensio JA, Trunkey D, editors. Current therapy of trauma and surgical critical care. Second edition. Philadelphia: Elsevier; 2016. p. 260-73.

DeMuth WE, Smith JM. Pulmonary contusion. Am J Surg. 1965;109:819-23.

https://doi.org/10.1016/S0002-9610(65)80061-7

Moguissi K. Laceration of the lung following blunt trauma. Thorax. 1971;26:223-8.

https://doi.org/10.1136/thx.26.2.223

Jones NS. An audit of the management of 250 pa- tients with chest trauma in a regional thoracic surgical centre. Arch Emerg Med. 1989;6:97-106.

https://doi.org/10.1136/emj.6.2.97

Roostar L. Indications for surgery in penetrating chest injuries. Ann Chir Gynaecol. 1993;82:177-81.

Marts B, Durham R, Shapiro M, Mazuski JE, Zuc- kerman D, Sundaram M, et al. Computed tomogra- phy in the diagnosis of blunt thoracic injury. Am J Surg. 1994;168:688-92.

https://doi.org/10.1016/S0002-9610(05)80146-1

Stewart KC, Urschel JD, Nakai SS, Gelfand ET, Hamil- ton SM. Pulmonary resection for lung trauma. Ann Thorac Surg. 1997;63:1587-8.

https://doi.org/10.1016/S0003-4975(97)00442-6

Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg KP. Operative chest wall sta- bilization in flail chest--outcomes of patients with or without pulmonary contusion. J Am Coll Surg. 1998;187:130-8.

https://doi.org/10.1016/S1072-7515(98)00142-2

Wall MJ Jr, Villavicencio RT, Miller CC 3rd, Aucar JA, Granchi TA, Liscum KR, et al. Pulmonary trac- totomy as an abbreviated thoracotomy technique. J Trauma. 1998;45:1015-23.

https://doi.org/10.1097/00005373-199812000-00008

Cothren C, Moore EE, Biffl WL, Franciose RJ, Off- ner PJ, Burch JM. Lung-sparing techniques are as- sociated with improved outcome compared with anatomic resection for severe lung injuries. J Trau- ma. 2002;53:483-7.

https://doi.org/10.1097/00005373-200209000-00015

Leone M, Albanèse J, Rousseau S, Antonini F, Dubuc M, Alliez B, et al. Pulmonary contusion in severe head trauma patients: Impact on gas exchange and outcome. Chest. 2003;124:2261-6.

https://doi.org/10.1378/chest.124.6.2261

Busche MN, Gohritz A, Seifert S, Herold C, Ipak- tchi R, Knobloch K, et al. Trauma mechanisms, pat- terns of injury, and outcomes in a retrospective study of 71 burns from civil gas explosions. J Trau- ma. 2010;69:928-33.

https://doi.org/10.1097/TA.0b013e3181ca03f7

Perna V, Morera R. Prognostic factors in chest traumas: A prospective study of 500 patients. Cir Esp. 2010;87:165-70. 18. Clarke DL, Quazi MA, Reddy K, Thomson SR. Emer- gency operation for penetrating thoracic trauma in a metropolitan surgical service in South Africa. J Tho-rac Cardiovasc Surg. 2011;142:563-8.

https://doi.org/10.1016/j.jtcvs.2011.03.034

de Moya MA, Manolakaki D, Chang Y, Amygdalos I, Gao F, Alam HB, et al. Blunt pulmonary contusion: Admission computed tomography scan predicts me- chanical ventilation. J Trauma. 2011;71:1543-7.

https://doi.org/10.1097/TA.0b013e31822c4a8b

Bilello JF, Davis JW, Cagle KM, Kaups KL. Pre- dicting extubation failures in blunt trauma patients with pulmonary contusion. J Trauma Acute Care Surg. 2013;75:229-33.

https://doi.org/10.1097/TA.0b013e3182946649

Stübig T, Brand S, Zeckey C, Beltran MJ, Otte D, Krettek C, et al. Thoracic injuries sustained by severely in- jured front-seat passengers and drivers: Injury patterns and their relationship to crash characteristics. Int J Inj Contr Saf Promot. 2013;20:313-20.

https://doi.org/10.1080/17457300.2012.724692

Jin H, Tang LQ, Pan ZG, Peng N, Wen Q, Tang YQ, et al. Ten-year retrospective analysis of multiple trau- ma complicated by pulmonary contusion. Mil Med Res. 2014;1:7. doi: 10.1186/2054-9369-1-7

https://doi.org/10.1186/2054-9369-1-7

Subhani SS, Muzaffar MS, Siddiqui FR. Blunt thora- cic trauma -an analysis of 264 patients in Rawalpin- di, Pakistan. J Pak Med Assoc. 2014;64:375-8.

Daurat A, Millet I, Roustan JP, Maury C, Taourel P, Jaber S. Thoracic trauma severity score on ad- mission allows to determine the risk of dela- yed ARDS in trauma patients with pulmonary con- tusion. Injury. 2016;47:147-53.

https://doi.org/10.1016/j.injury.2015.08.031

Elbaih A, Elshaboury I, Kalil N, El-Aouty H. Evalua- tion of thoracic trauma severity score in predicting the outcome of isolated blunt chest trauma patients. Int J Surg Med. 2016;2:100-6.

https://doi.org/10.5455/ijsm.chesttrauma

Mahmood I, El-Menyar A, Younis B, Ahmed K, Nabir S, Ahmed MN, et al. Clinical significance and prog- nostic implications of quantifying pulmonary contu- sion volume in patients with blunt chest trauma. Med Sci Monit. 2017;23:3641-8.

https://doi.org/10.12659/MSM.902197

Pyke OJ Jr, Rubano JA, Vosswinkel JA, McCormack JE, Huang EC, Jawa RS. Admission of elderly blunt tho- racic trauma patients directly to the intensive care unit improves outcomes. J Surg Res. 2017;219:334-40.

https://doi.org/10.1016/j.jss.2017.06.054

Bader A, Rahman U, Morris M, McCormack JE, Huang EC, Zawin M, et al. Pulmonary contusions in the el- derly after blunt trauma: Incidence and outcomes. J Surg Res. 2018;230:110-6.

https://doi.org/10.1016/j.jss.2018.04.049

Boddaert G, Mordant P, Le Pimpec-Barthes F, Mar- tinod E, Aguir S, Leprince, P et al. Surgical manage- ment of penetrating thoracic injuries during the Paris attacks on 13 November 2015. Eur J Cardiothorac Surg. 2017;51:1195-202.

https://doi.org/10.1093/ejcts/ezx036

Ozmen CA, Onat S, Aycicek D. Radiologic findings of thoracic trauma. Ther Clin Risk Manag. 2017;13:1085-9.

https://doi.org/10.2147/TCRM.S143845

Bugge-Asperheim B, Svennevig JL, Birkeland S. Hae- modynamic and metabolic consequences of lung con- tusion following blunt chest trauma. Scand J Thorac Cardiovasc Surg. 1980;14:295-9.

https://doi.org/10.3109/14017438009101015

Roscher R, Bittner R, Stockmann U. Pulmonary contusion. Arch Surg. 1974;109:508-10.

https://doi.org/10.1001/archsurg.1974.01360040030008

Wall MJ Jr, Villavicencio RT, Miller CC 3rd, Aucar JA, Granchi TA, Liscum KR, et al. Pulmonary trac- totomy as an abbreviated thoracotomy technique. J Trauma. 1998;45:1015-23.

https://doi.org/10.1097/00005373-199812000-00008

Miller PR, Croce MA, Bee TK, Qaisi WG, Smith CP, Collins GL, et al. ARDS after pulmonary contusion: Accurate measurement of contusion volume identifies high-risk patients. J Trauma. 2001;51:223-8. 35. Velmahos GC, Baker C, Demetriades D, Goodman J, Murray JA, Asensio JA. Lung-sparing surgery after penetrating trauma using tractotomy, partial lobecto- my, and pneumonorrhaphy. Arch Surg. 1999;134: 186-9. 36. Karmy-Jones R, Jurkovich GJ, Shatz DV, Brundage S, Wall MJ Jr, Engelhardt S, et al. Management of trau- matic lung injury: A Western Trauma Association Multicenter review. J Trauma. 2001;51:1049-53.

Amital A, Shitrit D, Fox BD, Raviv Y, Fuks L, Terner I, et al. Long-term pulmonary function after recov- ery from pulmonary contusion due to blunt chest trauma. Isr Med Assoc J. 2009;11:673-6.

Strumwasser A, Chu E, Yeung L, Miraflor E, SadjadiJ, Victorino GP. A novel CT volume index score corre- lates with outcomes in polytrauma patients with pul- monary contusion. J Surg Res. 2011;170:280-5.

https://doi.org/10.1016/j.jss.2011.03.022

Wang S, Ruan Z, Zhang J, Jin W. The value of pulmonary contusion volume measurement with three-dimensio- nal computed in predicting acute respiratory distress syn- drome development. Ann Thorac Surg. 2011; 92:1977-83.

https://doi.org/10.1016/j.athoracsur.2011.05.020

Becher RD, Colonna AL, Enniss TM, Weaver AA, Crane DK, Martin RS, et al. An innovative ap- proach to predict the development of adult respira- tory distress syndrome in patients with blunt trauma. J Trauma Acute Care Surg. 2012;73:1229-35.

https://doi.org/10.1097/TA.0b013e31825b2124

Alisha C, Gajanan G, Jyothi H. Risk factors affecting the prognosis in patients with pulmonary contusion fo- llowing chest trauma. J Clin Diagn Res. 2015;9:OC17-9.

https://doi.org/10.7860/JCDR/2015/13285.6375

Chou YP, Kuo LC, Soo KM, Tarng YW, Chiang HI, Huang FD, et al. The role of repairing lung la- cerations during video-assisted thoracoscopic surgery evacuations for retained haemothorax cau- sed by blunt chest trauma. Eur J Cardiothorac Surg. 2014;46:107-11.

https://doi.org/10.1093/ejcts/ezt523

Bowling R, Mavroudis C, Richardson JD, Flint LM, Howe WR, Gray LA Jr. Emergency pneumonec- tomy for penetrating and blunt trauma. Am Surg. 1985;51:136-9.

Halonen-Watras J, O'Connor J, Scalea T. Trauma- tic pneumonectomy: A viable option for patients in extremis. Am Surg. 2011;77:493-7.

Shapiro MJ, Keegan MJ. Continuous oscillation the- rapy for the treatment of pulmonary contusion. Am Surg. 1992;58:546-50.

Thompson DA, Rowlands BJ, Walker WE, Kuyken- dall RC, Miller PW, Fischer RP. Urgent thoraco- tomy for pulmonary or tracheobronchial injury. J Trauma. 1988;28:276-80.

https://doi.org/10.1097/00005373-198803000-00002

Wiencek RG Jr, Wilson RF. Central lung injuries: A need for early vascular control. J Trauma. 1988;28:1418-24.

https://doi.org/10.1097/00005373-198810000-00002

Keneally R, Szpisjak D. Thoracic trauma in Iraq and Af- ghanistan. J Trauma Acute Care Surg. 2013;74:1292-7.

https://doi.org/10.1097/TA.0b013e31828c467d

Stanić V. The advantages of limited resection vs. sutu- re in the primary management of penetrating lung war wounds. Vojnosanit Pregl. 1998;55:583-90.

Tsehai G, Wolde-Michael G. Treatment of penetrating wounds of the chest. Ethiop Med J. 1980;18:81-9.

Smith JE. The epidemiology of blast lung injury du- ring recent military conflicts: A retrospective data- base review of cases presenting to deployed military hospitals, 2003-2009. Philos Trans R Soc Lond B Biol Sci. 2011;366:291-4.

https://doi.org/10.1098/rstb.2010.0251

Propper BW, Gifford SM, Calhoon JH, McNeil JD. War- time thoracic injury: Perspectives in modern warfare. Ann Thorac Surg. 2010;89:1032-5.

https://doi.org/10.1016/j.athoracsur.2010.01.014

Belmont PJ Jr, McCriskin BJ, Sieg RN, Burks R, Schoenfeld AJ. Combat wounds in Iraq and Afgha- nistan from 2005 to 2009. J Trauma Acute Care Surg. 2012;73:3-12.

https://doi.org/10.1097/TA.0b013e318250bfb4

Fallouh H, Dattani-Patel R, Rathinam S. Blunt thoracic trauma. Surgery. 2017;35:262-8.

https://doi.org/10.1016/j.mpsur.2017.02.005

Hoth JJ, Scott MJ, Bullock TK, Stassen NA, Franklin GA, Richardson JD. Thoracotomy for blunt trau- ma: Traditional indications may not apply. Am Surg. 2003;69:1108-11.

Arajärvi E, Santavirta S. Chest injuries sustained in se- vere traffic accidents by seatbelt wearers. J Trauma. 1989;29:37-41.

https://doi.org/10.1097/00005373-198901000-00007

Kishikawa M, Yoshioka T, Shimazu T, Sugimoto H, Yoshioka T, Sugimoto T. Pulmonary contusion cau- ses long-term respiratory dysfunction with decreased functional residual capacity. J Trauma. 1991;31:1203-8.

https://doi.org/10.1097/00005373-199109000-00002

Rashid MA, Wikström T, Ortenwall P. Outco- me of lung trauma. Eur J Surg. 2000;166:22-8.

https://doi.org/10.1080/110241500750056490

Nishiumi N, Inokuchi S, Oiwa K, Masuda R, Iwazaki M, Inoue H. Diagnosis and treatment of deep pul- monary laceration with intrathoracic haemorrhage from blunt trauma. Ann Thorac Surg. 2010;89:232-8.

https://doi.org/10.1016/j.athoracsur.2009.09.041

Turkalj I, Petrović K, Stojanović S, Petrović D, Brakus A, Ristić J. Blunt chest trauma-an audit of injuries di- agnosed by the MDCT examination. Vojnosanit Pre- gl. 2014;71:161-6.

https://doi.org/10.2298/VSP1402161T

Bastos R, Calhoon JH, Baisden CE. Flail chest and pul- monary contusion. Semin Thorac Cardiovasc Surg. 2008;20:39-45.

https://doi.org/10.1053/j.semtcvs.2008.01.004

Carzolio-Trujillo HA, Navarro-Tovar F, Padilla-Gómez CI, Hernández-Martínez IA, Herrera-Enríquez J. Blunt chest trauma with pneumomediastinum and pneumoperitoneum secondary to Macklin effect. Case report. Cir Cir. 2016;84:409-14. doi: 10.1016/j.cir- cir.2015.05.055

https://doi.org/10.1016/j.circen.2016.08.004

Mercurio I, Capano D, Torre R, Taddei A, Troiano G, Scialpi M, et al. A case of fatal cerebral air embolism af- ter blunt lung trauma: Postmortem computed tomog- raphy and autopsy findings. Am J Forensic Med Pathol. 2018;39:61-8. doi: 10.1097/PAF.0000000000000375

https://doi.org/10.1097/PAF.0000000000000375

Boffard KD. Manual of definitive surgical trauma care. Fourth edition. Boca Raton, FL: CRC Press; 2016. p. 342. 65. Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ, et al. Organ inju- ry scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm. J Trauma. 1994;36:299-300.

https://doi.org/10.1097/00005373-199403000-00002

Petrone P, Asensio JA. Surgical management of penetrating pulmonary injuries. Scand J Trauma Resusc Emerg Med. 2009;17:8. doi: 10.1186/1757-7241-17-8

https://doi.org/10.1186/1757-7241-17-8

Cohn SM, Dubose JJ. Pulmonary contusion: An update on recent advances in clinical management. World J Surg. 2010;34:1959-70.

https://doi.org/10.1007/s00268-010-0599-9

Durso AM, Caban K, Munera F. Penetrating thoracic injury. Radiol Clin North Am. 2015;53:675-93.

https://doi.org/10.1016/j.rcl.2015.02.010

Zreik NH, Francis I, Ray A, Rogers BA, Ricketts DM. Blunt chest trauma: Soft tissue injury in the thorax. Br J Hosp Med. 2016;77:78-83. doi: 10.12968/hmed.2016.77.2.78 70. Freixinet J, Ramírez ME, Gallardo G, Moreno P. Traumatismos torácicos. Arch Bronconeumol. 2011;47(Suppl.3):9-14.

https://doi.org/10.12968/hmed.2016.77.2.78

Wagner RB, Jamieson PM. Pulmonary contusion. Evaluation and classification by computed tomography. Surg Clin North Am. 1989;69:31-40.

https://doi.org/10.1016/S0039-6109(16)44732-8

Błasińska-Przerwa K, Pacho R, Bestry I. The application of MDCT in the diagnosis of chest trauma. Pneumonol Alergol Pol. 2013;81:518-26.

Lang P, Kulla M, Kerwagen F, Lefering R, Friemert B, Palm HG. The role of whole-body computed tomo- graphy in the diagnosis of thoracic injuries in severely injured patients - a retrospective multi-centre study ba- sed on the trauma registry of the German trauma so- ciety (Trauma Register DGU®). Scand J Trauma Resusc Emerg Med. 2017;25:82. doi: 10.1186/s13049-017-0427-4

https://doi.org/10.1186/s13049-017-0427-4

Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: Development of a standardized scoring system for initial clinical decision making. J Trauma. 2000;49:496-504.

https://doi.org/10.1097/00005373-200009000-00018

Mattila SP. Penetrating chest injuries. Ann Chir Gynae- col Fenn. 1974;63:297-303.

Paci M, Annessi V, de Franco S, Ferrari G, Sgarbi G. Videothoracoscopic evaluation of thoracic injuries. Chir Ital. 2002;54:335-9.

Mokoena T. Emergency surgery for major pulmonary injury. J Coll Physicians Surg Pak. 2016;26:60-2. doi: 01.2016/JCPSP.6062

ATLS Subcommittee; American College of Surgeons' Committee on Trauma; International ATLS working group. Advanced trauma life support (Student Course Manual ATLS®). 9th edition. Chicago, IL; 2012. p. 392.

Karmy-Jones R, Jurkovich GJ, Nathens AB, Shatz DV, Brundage S, Wall MJ Jr, et al. Timing of urgent thora- cotomy for hemorrhage after trauma: A multicenter study. Arch Surg. 2001;136:513-8.

https://doi.org/10.1001/archsurg.136.5.513

Descargas

Publicado

2019-06-20

Cómo citar

(1)
Petrone, P.; Ruano Campos, A.; Gendy, A.; Brathwaite, C. E.; Joseph, D. . A. K. Prevalencia, diagnóstico Y Tratamiento De Las Lesiones Pulmonares traumáticas. Rev Colomb Cir 2019, 34, 132-143.

Número

Sección

Artículo Original

Métricas

Crossref Cited-by logo
QR Code

Algunos artículos similares: