Serial Evaluation of Pulmonary Funtion Long-Term after Lung Contusion

Lung contusions (LC) in children are frequent findings after road accidents. Possible residual lesions may potentially influence long-term pulmonary development. Forty four patients injured at the age of 10.0±4.0 years (ranged 2.3–17.5) were diagnosed and treated for LC. These children were studied serially 2.0±1.8 (ranged 0.1–6.6)yrs and later again 8.4±3.3 (ranged 0.8–12.6)yrs after injury (only 21 subject accessible). The same protocol was used in both studies: static lung volumes, lung elasticity and airway patency. Twenty nine of them were ventilated by conventional CMV 13.9±14.0 (ranged 2–70) days, FiO₂ 0.50±0.2 (ranged 0.3–0.4). The following findings were detected during therapy: pneumo- or hemothorax (n=6), sepsis (n=18), ARDS (n=6) and/or ribs/clavicle fractures (n=14). No previous history of chronic lung disease was ascertained.

	1st study (N=44)				2nd study (N=21)
	meas.		% ref		meas.		% ref		Δ
	mean	SD	mean	SD	mean	SD	mean	SD		P <
vital capacity (VC)	3020	1240	96	12	4197	789	103	11	↑	0.002
total lung capacity (TLC)	4083	1468	97	12	5391	937	102	12	≈	NS
residual volume (RV)	975	454	99	37	1174	405	99	35	≈	NS
RV/TLC	24.0	7.5	101	31	21.6	6.4	96	29	↓	0.04
static lung compliance/TLC (Cst/TLC)	0.034	0.007	91	20	0.039	0.015	110	44	↑	0.01
lung recoil at 100% TLC (Pst 100)	44.5	8.7	123	30	47.6	11.7	119	31	≈	NS
specific airway conductance (sGaw)	0.155	0.047	79	24	0.134	0.047	109	64	≈	NS
peak expiratory flow (PEF)	5.8	2.2	99	21	7.6	2.1	105	23	↑	0.04
MEF at 25%VC/TLC	0.439	0.193	92	32	0.397	0.128	87	22	≈	NS
MEF at 50%VC/TLC	0.893	0.390	97	26	0.824	0.227	96	22	≈	NS

Normal lung size and normal airway patency without hyperinflation were found 2yrs after LC. These findings persisted over next 6 years after injury. Initial finding of stiffer lung normalized in the 2^nd study.In conclusion, despite serious lung injury during childhood the next favourable lung development until adolescence was found.

Supported by grant NE 7641–3 and MSM 111100008