Blunt Chest Trauma

Blunt chest trauma is a leading cause of emergency hospital visits and can result in severe breathing complications such as hypoxemic respiratory failure. While computed tomography (CT) scans provide detailed imaging of the chest, their routine use is limited by radiation exposure, high cost, and the inability to perform frequent bedside monitoring. Bedside lung ultrasound (LUS) is commonly used to detect structural injuries like lung contusions or collapsed lungs, but it cannot assess how well the breathing muscles are working. Because acute respiratory failure after chest trauma involves both lung tissue damage and impaired breathing muscle mechanics, combining lung ultrasound with diaphragmatic ultrasound may improve early risk assessment. The primary purpose of this prospective cohort study is to determine whether combining point-of-care lung ultrasound with diaphragmatic ultrasound provides better early prediction of hypoxemic respiratory failure than lung ultrasound alone in adult patients with isolated blunt chest trauma. Participants will undergo bedside lung ultrasound, diaphragmatic ultrasound, and arterial blood gas testing at four standardized time points: upon hospital admission (baseline), and at 6, 12, and 24 hours after admission. The lung ultrasound examination assesses the degree of lung tissue injury using a standardized 12-zone Lung Ultrasound Score (LUS). Diaphragmatic ultrasound measures muscle movement (diaphragmatic excursion) and contraction strength (diaphragm thickening fraction). Arterial blood gas results will be used to track oxygenation via the PaO2/FiO2 ratio, with a ratio of 300 mmHg or lower defining hypoxemic respiratory failure. All participants will also receive a standard-of-care chest CT scan as a reference comparison. The study aims to evaluate whether this non-invasive, radiation-free bedside approach helps emergency physicians identify high-risk patients earlier, guiding timely respiratory support and intensive care triage while minimizing the need for repeated CT scans.

In our previous study, the investigators analyzed more than 30,000 cases from the National Trauma Center Database and found that 66.4% of patients with severe blunt chest trauma had concurrent rib fractures, 55.87% had multiple fractures (≥4 ribs), and 37.4% had combined pulmonary contusion. In a further prospective observational cohort study evaluating the efficacy of EIT-guided OLE in such patients, results demonstrated that this protocol improved the ventilation-perfusion ratio and oxygenation index and shortened total mechanical ventilation duration. Based on literature review and preliminary findings, the investigators propose the following hypothesis: the application of EIT-noninvasively monitored OLE airway clearance in patients with severe blunt chest trauma can improve the ventilation-perfusion ratio, shorten mechanical ventilation time, reduce the incidence of complications such as pulmonary infection and mortality, and decrease medical resource consumption. This study will verify this hypothesis through a prospective randomized controlled trial and further refine the specific implementation protocol of OLE to enhance its scientific validity and clinical applicability.

This study aims to evaluate the effectiveness of an innovative, non-invasive chest stabilizer in patients with multiple rib fractures caused by blunt chest trauma. Rib fractures often lead to severe pain, breathing difficulties, and complications such as pneumonia or atelectasis. Participants will be randomly assigned to one of two groups: standard pain management or the new chest stabilizer, which will be used for 10 days. The study will assess improvements in pain levels, breathing function (including FVC, FEV1, and PEF), and the occurrence of lung-related complications. Additional outcomes such as hospital stay, patient comfort, and skin reactions related to the device will also be evaluated. The goal of this research is to determine whether the innovative stabilizer can provide safer, more comfortable, and more effective treatment compared with current standard care for rib fracture patients.