Post pneumonectomy pulmonary oedema

[Hardcastle, Tim, Dr <tch at sun.ac.za>]

Karim

Post-operative fluid redistribution and rapid onset fulminant pulmonary oedema. His extubation may have been too early - the positive pressure controls the fluid shifts and once it is removed he starts to leak into the alveoli; slowly drowning in his own third space fluid, given that his right heart will be maximally strained the first 48 hours post-pneumonectomy. Happended to the last patient we did one of these on - ours was blunt trauma. The reported literature survival of pneumonectomy for trauma, specifically in the damage control context is BAD.

Better luck next time.

Tim (yes - I'm back at last!)
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Karim Brohi
Sent: Tuesday, February 12, 2008 5:31 AM
To: 'Trauma & Critical Care mailing list'
Subject: Post pneumonectomy pulmonary oedema


Recently had a fit adult admitted following penetrating injury to the right
chest with injury of the lower lobe of the lung extending to the hilum with
associated extra-pericardial pulmonary vein laceration.  Had a right
pneumonectomy as very coagulopathic with oversew of the pulmonary vein. 

Initially did well, extubated at 24 hours, comfortable, haemoserous drainage
from chest tubes. 12 hours later after a couple of transient dips in
saturation developed acute pulmonary oedema, froth coming up the ET tube,
and died within minutes.  

Any ideas?

Karim

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