ICU · Respiratory

Pulmonary contusion and blunt chest trauma

Also known as Pulmonary contusion · Blunt chest injury · Flail chest · Blunt aortic injury

Pulmonary contusion is bruising of the lung parenchyma from blunt chest trauma (motor vehicle crash, fall, crush, blast). Alveolar-capillary disruption → alveolar haemorrhage + interstitial/peribronchial oedema → impaired gas exchange (V/Q mismatch → true shunt) + reduced compliance → progressive hypoxaemia that develops and WORSENS over 24-48h (worsens before improving). Often associated with rib fractures (1 association), flail chest (≥3 consecutive ribs fractured in ≥2 places — paradoxical breathing), pneumothorax, haemothorax, blunt aortic injury and cardiac (myocardial) contusion. Management: oxygen (escalate via HFNC/NIV), analgesia (epidural or thoracic paravertebral block for rib fractures), JUDICIOUS fluids (avoid overload — worsens contusion), NIV if moderate respiratory distress, intubation + lung-protective ventilation (Vt 6 mL/kg PBW) if severe. Monitor for: ARDS (develops in ~20% of severe contusions), pneumonia, respiratory failure — mortality 10-25%. CXR may be NORMAL initially (lags 24-48h); CT chest is more sensitive and quantifies contusion volume.