During the 10 years from 1968 a total of 1119 patients with chest and associated injuries were admitted to the Royal Newcastle Hospital (RNH); 530 of these needed ICU treatment and fifty‐nine died. Common causes of death included irreparable associated injuries to brain and exsanguination due to major vessel injury. However, the commonest cause encountered was refractory respiratory failure due to pulmonary sepsis. This condition was associated with hypovolaemic shock, intra‐abdominal injuries, failure of conservative treatment and injuries in the older age gro