Objective: To describe the management of blunt thoracic trauma patients admitted to the intensive care unit, and to provide a strategy for their management. Search strategy: The literature was reviewed using several sources: Pubmed, textbooks, guidelines of thoracic societies. Where available, data from patients admitted to intensive care units were assessed. Articles focusing on surgical techniques for chest trauma were discarded. Summary of findings: The assessment of the literature shows that chest trauma is the second most frequent and lethal injury in the modern era. The performance of computed tomography is excellent, which makes it possible to diagnose most injuries without delay. In contrast, most management procedures rely on an empiric approach because of the weakness of the level of evidence in this field. Protective ventilation, safe procedures to insert a chest drain and adequate administration of analgesics are the basis of the management of patients with chest trauma. Worsening the outcome by an excessively aggressive approach should be avoided. Conclusion: The injuries of patients with chest blunt trauma are presently well-depicted, but there is a need for randomized clinical trials in order to progress in their management. © 2010, Nederlandse Vereniging voor Intensive Care.