REVIEWING THE ROLE OF INTRAVENOUS STEROIDS IN BLUNT CHEST TRAUMA-LUNG CONTUSION
DOI:
https://doi.org/10.22159/ajpcr.2022.v15i9.45245Keywords:
Pulmonary, Contusion, Steroids, Chest, TraumaAbstract
Objective: The aim of the study was to see the effect of intravenous steroids in patients with blunt chest trauma-lung contusion and to compare the effect of steroid use based on improvement in oxygen saturation, ABG, and hospital stay, in the study group and control group.
Methods: A prospective and observational study was carried out on patients with blunt chest trauma having lung contusion who were admitted to the multispecialty hospital for 2 years. Data were collected in a predesigned proforma. All patients with radiologically proven lung contusion were observed based on the steroid treatment given or not. Group A was steroid (study) group and Group B was non-steroid (control) group with 25 sample size in each group. Group A patients were treated with steroid (hydrocortisone) 20 mg/kg/day 6 hourly which was tapered over time. Control group patients were treated identically except for steroid use.
Results: Most of the injuries affected the middle age group (25 to 65 years) which accounted for a total of 84%. The percentage of males and females in the study were 76% and 24%, respectively. The most common mode of injury was road traffic accidents which account for 76% as compared to non-road traffic accidents (24%). Statistical analysis showed there was an improvement in both groups in parameters such as Spo2, ABG-Pco2, and ABG-Sao2 and were statistically significant. While other improvements like ABG-Po2, radiological CT, and hospital stays were statistically insignificant.
Conclusions: As both groups were showing improvements and there was no statistically much difference seen in both groups, we concluded that there is no role of intra-venous steroid use in lung contusion. However, every patient must undergo CT for a better assessment of the injury. Objective scoring systems are required in CT assessment of lung injury and studies with increased sample size and carried out at multiple centers are required for better conclusions.
Downloads
References
Collins J, Stern EJ. Chest Radiology: The Essentials. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins; 2007. p. 120.
Wicky S, Wintermark M, Schnyder P, Capasso P, Denys A. Imaging of blunt chest trauma. Eur Radiol 2000;10:1524-38. doi: 10.1007/ s003300000435, PMID 11044920.
Stern EJ, White C. Chest Radiology Companion. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins; 1999. p. 103.
Livingston DH, Hauser CJ. Trauma to the chest wall and lung. In: Moore EE, Feliciano DV, Mattox KL, editors. Trauma. 5th ed. United States: McGraw-Hill Professional; 2003. p. 525-8.
Costantino M, Gosselin MV, Primack SL. The ABC’s of thoracic trauma imaging. Semin Roentgenol 2006;41:209-25. doi: 10.1053/j. ro.2006.05.005, PMID 16849051.
Miller DL, Mansour KA. Blunt traumatic lung injuries. Thorac Surg Clin 2007;17:57-61. doi: 10.1016/j.thorsurg.2007.03.017, PMID 17650697.
Wanek S, Mayberry JC. Blunt thoracic trauma: Flail chest, pulmonary contusion, and blast injury. Crit Care Clin 2004;20:71-81. doi: 10.1016/ s0749-0704(03)00098-8, PMID 14979330.
Mick NW, Peters JR, Egan D, Nadel ES, Walls R, Silvers S. Chest trauma. In: Blueprints Emergency Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p. 76.
Coyer F, Ramsbotham J. Respiratory health breakdown. In: Chang E, Daly J, Eliott D, editors Pathophysiology Applied to Nursing. Marrickville, NSW: Mosby Australia; 2004. p. 154-5.
Boyd AD. Lung injuries. In: Hood RM, Boyd AD, Culliford AT, editors. Thoracic Trauma. Philadelphia, PA: Saunders; 1989. p. 153-5.
Gavelli G, Canini R, Bertaccini P, Battista G, Bnà C, Fattori R. Traumatic injuries: Imaging of thoracic injuries. Eur Radiol 2002;12:1273-94. doi: 10.1007/s00330-002-1439-6, PMID 12042932.
Yamamoto L, Schroeder C, Morley D, Beliveau C. Thoracic trauma: The deadly dozen. Crit Care Nurs Q 2005;28:22-40. doi: 10.1097/00002727-200501000-00004, PMID 15732422.
Peitzman AB, Rhoades M, Schwab CW, Yealy DM, Fabian TC. The Trauma Manual: Trauma and Acute Care Surgery (Spiral Manual Series). 3rd ed. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins; 2007. p. 223.
Modell JH, Graves SA, Ketover A. Clinical course of 91 consecutive near-drowning victims. Chest 1976;70:231-8. doi: 10.1378/ chest.70.2.231, PMID 780069.
Svennevig JL, Bugge-Asperheim B, Bjørgo S, Kleppe H, Birkeland S. Methylprednisolone in the treatment of lung contusion following blunt chest trauma. Scand J Thorac Cardiovasc Surg 1980;14:301-5. doi: 10.3109/14017438009101016, PMID 7013060.
Akdemir HU, Güzel A, Katı C, Duran L, Alaçam H, Gacar A, et al. The evaluation of different treatment protocols for trauma-induced lung injury in rats. J Thorac Dis 2014;6:66-73. doi: 10.3978/j.issn.2072- 1439.2013.12.54, PMID 24605218.
Franz JL, Richardson JD, Grover FL, Trinkle JK. Effect of methylprednisolone sodium succinate onexperimental pulmonary contusion. J Thorac Cardiovasc Surg 1974;68:842Y844. doi: 10.1016/ S0022-5223(19)41649-8, PMID 4607745.
Simon B, Ebert J, Bokhari F, Capella J, Emhoff T, Hayward T, et al. Management of pulmonary contusion and flail chest: An eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg 2012;73:S351-61. doi: 10.1097/ TA.0b013e31827019fd, PMID 23114493.
Published
How to Cite
Issue
Section
Copyright (c) 2022 Ravishekar N Hiremath
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.
