Pulmonary Contusion in Severe Head Trauma Patients* Impact on Gas Exchange and Outcome

Study objective: To evaluate the impact on morbidity and mortality of pulmonary contusion in multiple-trauma patients with severe head trauma. Design: Matched-paired, case-control study Setting: ICU at a tertiary university hospital. Patients: During a 3-year period, 313 consecutive multiple-trauma patients with severe head trauma (Glasgow coma scale [GCS], < 8) who were admitted to the ICU. Interventions: Case-control matching criteria were as follows: (1) age difference within 5 years; (2) sex; (3) GCS in two categories; (4) similar pattern of injury; and (5) simplified acute physiology score II in five categories. A pulmonary contusion, defined by the clinical context and the result of a chest CT scan, was diagnosed in 90 patients. Analysis was performed on 90 pairs who were matched with 100% success. Results: Ninety patients (29%) presented a diagnosis of pulmonary contusion. The presence of pulmonary contusion had an impact on the PaO2/fraction of inspired oxygen (FIO2) ratio, which was significantly reduced in patients with a pulmonary contusion. The ICU stay, the occurrence of complications such as nosocomial pneumonia or ARDS, the Glasgow outcome scale, and the mortality rate did not significantly differ between case patients and control subjects. Mortality also was not affected when patients were stratified according to the severity of the PaO2/FIO2 ratio. Conclusion: In the study patients, pulmonary contusion alters gas exchange but does not appear to increase the morbidity and mortality of multiple-trauma patients with head trauma. A sample-size effect may limit the interpretation of the study. (CHEST 2003; 124:2261–2266)