Post pneumonectomy

[Karim Brohi]

So it turns out there is a sheep model of this, and some studies suggest
that it is hyper-inflation of the lung that leads to the pulmonary oedema.
(Small studies - certainly not what you'd classify as a flock).  The
attached X-ray is of this patient a couple of hours before the event.  The
film is rotated but there's no gross overinflation of the lung.

The authors of this study recommend balanced suction for the chest tube
drainage rather than free drainage or clamp-release regimens.  Any thoughts
on this?

Thanks

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Sanjay Gupta MD
Sent: 20 February 2008 20:37
To: Trauma &amp, Critical Care mailing list
Subject: RE: Post pneumonectomy 

One of the reasons why the patients with elective
pneumonectomy do better is, that usually the lung that
is resected is already diseased and a large part of
its function (and blood flow) has already been taken
over by the healthy lung. 


It would be interesting to see what the thoracic
surgeons on the list think about this. 

Sanjay




--- "Robert F. Smith" <rfsmithmd at comcast.net> wrote:

> Back in the day weren't pneumonectomies occasionally
> done for other
> pulmonary disease? Why were the outcomes better in
> more debilitated patients
> with elective surgery?
> 
> Rob Smith
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of KMATTOX at aol.com
> Sent: Monday, February 11, 2008 10:40 PM
> To: trauma-list at trauma.org
> Subject: Re: Post pneumonectomy pulmonary oedema
> 
> Karim:     I have seen this in far too many fit
> young  people.   It is far 
> more common than anyone writes about.    Humans with
> acute cytokine release 
> simply do not tolerate acute pneumonectomy  and
> CRASH between 12 and 18
> hours.   
> Perhaps should be maimntained on  membrane
> oxygenation and other supporting 
> mechanisms for 3-5  days.         I would suggest
> you  consider a "lung
> twist" to 
> damage control the bleeding.   Take back to  OR at
> 8-12 hours and reassess, 
> and then back 8-12 hours to reassess.    We need to
> talk about a good
> protocol 
> and a good experimental model.   
>  
> k
>  
>  
> In a message dated 2/11/2008 9:33:47 P.M. Central
> Standard Time,  
> karim at trauma.org writes:
> 
> 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?
> 
> 
> 
> 
> 
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Sanjay Gupta
Tel: 412 335 6304


 
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