Pulmonary contusion historical perspective

Jump to: navigation, search

Pulmonary contusion Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pulmonary contusion from other Diseases

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Future or Investigational Therapies

Case Studies

Case #1

Pulmonary contusion historical perspective On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pulmonary contusion historical perspective

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pulmonary contusion historical perspective

CDC on Pulmonary contusion historical perspective

Pulmonary contusion historical perspective in the news

Blogs on Pulmonary contusion historical perspective

Directions to Hospitals Treating Pulmonary contusion

Risk calculators and risk factors for Pulmonary contusion historical perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Historical Perspective

In 1761, the Italian anatomist Giovanni Battista Morgagni was first to describe a lung injury that was not accompanied by injury to the chest wall overlying it. The French military surgeon Guillaume Dupuytren is thought to have coined the term pulmonary contusion in the 19th century.[1] However, it was not until the early 20th century that pulmonary contusion and its clinical significance began to receive wide recognition.[2] With the use of explosives during World War I came many casualties with no external signs of chest injury but with significant bleeding in the lungs.[2] Studies of World War I injuries by D.R. Hooker showed that pulmonary contusion was an important part of the concussive injury that results from explosions.[2]

Giovanni Battista Morgagni, credited with having first described lung trauma without chest wall trauma

Pulmonary contusion received further attention during World War II, when the bombings of Britain caused blast injuries and associated respiratory problems in both soldiers and civilians. Also during this time, studies with animals placed at varying distances from a blast showed that protective gear could prevent lung injuries. These findings suggested that an impact to the outside of the chest wall was responsible for the internal lesions. In 1945, Buford and Burbank described what they called "wet lung", in which the lungs accumulated fluid and were simultaneously less able to remove it. They attributed the respiratory failure often seen in blunt chest trauma in part to excessive fluid resuscitation, and the question of whether and how much to administer fluids has remained controversial ever since.

During the Vietnam War, combat again provided the opportunity for study of pulmonary contusion; research during this conflict played an important role in the development of the modern understanding of its treatment. The condition also began to be more widely recognized in a non-combat context in the 1960s, and symptoms and typical findings with imaging techniques such as X-ray were described. Before the 1960s, it was believed that the respiratory insufficiency seen in flail chest was due to "paradoxical motion" of the flail segment of the chest wall (the flail segment moves in the opposite direction as the chest wall during respiration), so treatment was aimed at managing the chest wall injury, not the pulmonary contusion.[3] For example, positive pressure ventilation was used to stabilize the flail segment from within the chest. It was first proposed in 1965 that this respiratory insufficiency is most often due to injury of the lung rather than to the chest wall, and a group led by J.K. Trinkle confirmed this hypothesis in 1975.[4] Hence the modern treatment prioritizes the management of pulmonary contusion.[2] Animal studies performed in the late 1960s and 1970s shed light on the pathophysiological processes involved in pulmonary contusion.

References

  1. Karmy-Jones R, Jurkovich GJ (2004). "Blunt chest trauma". Current Problems in Surgery. 41 (3): 211–380. doi:10.1016/j.cpsurg.2003.12.004. PMID 15097979. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 2.2 2.3 EAST practice management workgroup for pulmonary contusion - flail chest: Simon B, Ebert J, Bokhari F, Capella J, Emhoff T, Hayward T; et al. (2006). "Practice management guide for Pulmonary contusion - flail chest" (PDF). The Eastern Association for the Surgery of Trauma. Retrieved 2008-06-18.
  3. Pettiford BL, Luketich JD, Landreneau RJ (2007). "The management of flail chest". Thoracic Surgery Clinics. 17 (1): 25–33. PMID 17650694. Unknown parameter |month= ignored (help)
  4. Bastos R, Calhoon JH, Baisden CE (2008). "Flail chest and pulmonary contusion". Seminars in Thoracic and Cardiovascular Surgery. 20 (1): 39–45. doi:10.1053/j.semtcvs.2008.01.004. PMID 18420125.



Linked-in.jpg