Recovery of Pulmonary Function After Crushing Injuries of the Chest

¹ Assistant Clinical Professor of Surgery, University of Minnesota, and Attending Thoracic Surgeon, U. S. Veterans Hospital, Minneapolis, and Minneapolis General Hospital.

The recovery of pulmonary function following crushing injury of the chest occurs in two phases. The early period after injury, during which time the battle for survival must be won, is one of seriously disturbed ventilation and vascularization of alveolar spaces. The second phase is characterized by residual disturbances in the thoracic musculoskeletal system and the pleural spaces. These must be corrected if efficient respiration is to be regained.

Minor crushing injuries with little or no paradoxical motion of the chest wall require strapping to stabilize the chest wall and relieve pain, tracheobronchial aspiration to maintain adequate airway, and little else. Pulmonary edema will occur in some degree in even these injuries and requires oxygen. If pulmonary edema is severe, the oxygen should be administered under positive pressure.

Severe crushing injuries involving one or both sides require tracheotomy with repeated catheter evacuation of tracheobronchial secretions and positive-pressure oxygen for a sufficient period to allow stabilization of the chest wall. Blood loss may be extensive and will require volumetric replacement. Pleural complications of hemothorax and pneumothorax require immediate catheter thoracotomy and suction drainage. Spreading and bothersome subcutaneous emphysema is promptly controlled by tracheotomy.

Decortication of all fibrinothoraces without undue delay will salvage pulmonary function in the second phase, particularly if every effort is made to redevelop the motion of the crippled side by early and persistent muscle training and respiratory exercises. Non-union of ribs and costochondral cartilages require resection for cure. These non-unions are painful and must be eliminated if good function is to redevelop.