From the Research
Respiratory management for crush injuries of the femur without fracture should prioritize maintaining adequate oxygenation and preventing potential complications, with initial management including supplemental oxygen to maintain SpO2 above 94%. The most recent and highest quality study 1 provides a comprehensive overview of crush injury and syndrome, highlighting the importance of early recognition and management of life-threatening injuries, including respiratory complications.
Key strategies for respiratory management include:
- Administering supplemental oxygen via nasal cannula, starting at 2-4 L/min and titrating as needed to maintain SpO2 above 94% 2
- Continuous pulse oximetry monitoring to assess oxygenation status
- Early mobilization when hemodynamically stable to prevent atelectasis and pneumonia
- Pain management with appropriate analgesics, such as morphine or hydromorphone, to prevent splinting and respiratory compromise
- Monitoring for rhabdomyolysis and acute kidney injury, which can lead to fluid overload and respiratory complications
In severe cases, aggressive fluid resuscitation with isotonic crystalloids may be necessary to prevent acute kidney injury, but fluid status must be carefully monitored to avoid pulmonary edema 1. The optimal timing of intubation in acute hypoxaemic respiratory failure is uncertain, but identifying patients at risk of hypoxemia during tracheal intubation can help target preventative interventions 3, 4.
Overall, a comprehensive approach to respiratory management, prioritizing oxygenation and preventing complications, is crucial for optimizing outcomes in patients with crush injuries of the femur without fracture.