SELECTIVE EXCLUSION OF THE INJURED LUNG

Intratracheal bleeding and intrapleural air leakage that are uncontrol lable by conventional therapy are life-threatening in patients with bl unt pulmonary trauma. Selective exclusion of the injured lung is the m ost effective treatment in such cases. Two hundred six consecutive pat ients over a 5-year period with blunt pulmonary trauma who survived 5 hours or more after arriving at the hospital were divided into three c ategories based on mode of treatment. In 190 (92%), intratracheal blee ding, intrapleural air leakage, and intrapleural bleeding were control lable by conventional treatment (class 1). In six (3%), intratracheal bleeding and intrapleural air leakage were controllable by selective p ulmonary exclusion, and intrapleural bleeding was controllable by tube thoracostomy (class 2). In ten (5%), thoracotomy was required because of uncontrollable intratracheal bleeding or intrapleural air leakage, despite selective pulmonary exclusion, or intrapleural hemorrhage was not controllable by tube thoracostomy (class 3). Among the 16 patient s with class 2 or 3 trauma, 14 survived.