Pulmonary contusions result in respiratory compromise due to
ventilation-perfusion mismatch, impaired pulmonary compliance, hypoxemia, or
hypercarbia. Management of minor pulmonary contusions consists of cautious
balanced fluid administration, supplemental oxygen, and aggressive pulmonary
toilet. Strict fluid management may limit alveolar edema. Incentive spirometry
and early mobilization are essential to prevent progressive atelectasis. In
cases of severe pulmonary contusions, additional oxygen therapy and
respiratory support may be indicated. Alert patients with marginal respiratory
status may be trialed with non-invasive positive pressure mask ventilation.
Respiratory failure warrants intubation and mechanical ventilatory support.
Sequelae from pulmonary contusions are frequent. The most common
secondary complication is pneumonia, occurring in 20% of affected children.
Less frequently, acute respiratory distress syndrome develops.
B. Pleural Injuries
Pneumothorax and hemothorax together are the second most common
intrathoracic injuries in pediatric chest trauma with an overall incidence of 41%
to 51%. Blunt injury from motor vehicle accidents, pedestrian accidents, and
falls are the most common causes. Pneumothorax in the setting of blunt
trauma occurs secondary to (1) pleural laceration or lung puncture due to
penetrating rib fractures; (2) increased intrathoracic pressure with rupture of
alveoli; (3) or air leak into the pleural space from tracheobronchial disruption.