Pneumonectomy for Trauma

Traumatic Pneumonectomy: A Viable Option

for Patients in Extremis
JILL HALONEN-WATRAS, M.D., JAMES O CONNOR, M.D., THOMAS SCALEA, M.D.
From the R Adams Cowley Shock Trauma Center, University of Maryland Medical System,

University of Maryland School of Medicine, Baltimore, Maryland

The combination of respiratory insufficiency, right heart failure, and depth of shock is thought to

result in mortality approaching 100 per cent after pneumonectomy. We did a retrospective review of

patients requiring pneumonectomy over 6 years. Data collected included demographics, emergency

department and operating room course, critical care management, complications, and mortality.

Seven patients were identified. Mean age was 26.5 years. Five sustained penetrating and two

sustained blunt trauma. Mean Injury Severity Score was 26 and Revised Trauma Score was 4.4.

Mean admission systolic blood pressure, lactate, and pH were 98 mm Hg, 10.1 mmol/L, and 6.98,

respectively. Mean time to operation was 49 minutes. Mean estimated blood loss was 5.4 liters and

mean intraoperative transfusion was 13.1 units of packed red blood cells. All seven developed rigbt

beart failure. Four required prone ventilation, one oscillating ventilation, four continuous renal

replacement, and tbree extracorporeal membrane oxygénation. Four patients died (57%); two of

refractory rigbt beart failure within the first 24 hours and two of multiple organ failure on postoperative

days 9 and 138. Mean length of stay in survivors was 71 days. All survivors were neurologically

intact and none required mechanical ventilation at discharge. Tbe need for pneumonectomy

after trauma is rare. Patients undergoing pneumonectomy wbo present in extremis require significant

intra and postoperative support, with a survival of 42 per cent.

from American Surgeon  2011 v77 p493-497

Thanks to Dr. Marc Mesleh for sending this article.