Management of thoracic trauma

Summary Managing major thoracic trauma begins with identifying and anticipating injuries associated with the mechanism of injury. The key aims are to reduce early mortality and the impact of associated complications to expedite recovery and restore the patient to their pre‐injury state. While imagin...

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Bibliographic Details
Published in:Anaesthesia 2023-02, Vol.78 (2), p.225-235
Main Authors: Lodhia, J. V., Eyre, L., Smith, M., Toth, L., Troxler, M., Milton, R. S.
Format: Article
Language:English
Subjects:
Analgesia
Analgesia - methods
Barotrauma
Complications
critical care
Gas exchange
Humans
Injuries
Injury prevention
Lung
Mechanical ventilation
Pain
Pain - etiology
Pain Management - methods
Pain perception
Recovery
Respiratory failure
Respiratory function
Side effects
surgery
Thoracic Injuries - complications
Thoracic Injuries - therapy
thoracic trauma
Thorax
Trauma
Ventilation
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Summary:Summary Managing major thoracic trauma begins with identifying and anticipating injuries associated with the mechanism of injury. The key aims are to reduce early mortality and the impact of associated complications to expedite recovery and restore the patient to their pre‐injury state. While imaging is imperative to identify the extent of thoracic trauma, some pathology may require immediate treatment. The majority can be managed with adequate pleural drainage, but respiratory failure and poor gas exchange may require either non‐invasive or invasive ventilation. Ventilation strategies to protect from complications such as barotrauma, volutrauma and ventilator‐induced lung injury are important to consider. The management of pain is vital in reducing respiratory complications. A multimodal strategy using local, regional and systemic analgesia may mitigate respiratory side effects of opioid use. With optimal pain management, physiotherapy can be fully utilised to reduce respiratory complications and enhance early recovery. Thoracic surgeons should be consulted early for consideration of surgical management of specific injuries. With a greater understanding of the mechanisms of injury and the appropriate use of available resources, favourable outcomes can be reached in this cohort of patients. Overall, a multidisciplinary and holistic approach results in the best patient outcomes.
ISSN:0003-2409
1365-2044
DOI:10.1111/anae.15934