Total Pulmonectomy in Trauma: A Still Unresolved Problem–Our Experience and Review of the Literature

Abstract

Emergency pneumonectomy for trauma is associated with very high mortality. Despite significant improvement of the intensive care resources, results of this procedure have not been improved during the last 20 years. When performed because of hemorrhagic shock, pneumonectomy is almost always fatal. We present a series of four patients who underwent total pneumonectomy in our trauma center. The main purpose of this study was to describe pathophysiologic changes and to discuss possible therapeutic alternatives based on the literature review after this operation.

Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma

“…Delayed repair attempts may have complications such as poorer lung function, an increased risk of empyema, and hilar abscesses [ 3 ]. Furthermore, the mortality of pneumonectomy for patients in shock approaches 100% due to uncontrolled hemorrhage or acute right heart failure [ 4 ]. During surgery, we considered a left pneumonectomy; however, we eventually decided to perform bronchial repair to promote early postoperative recovery and prevent post-pneumonectomy problems.…”

ECMO in trauma patients requiring total pulmonectomy: Could this be a new approach in the era of hybrid management?

“…Temporary vascular clamping or lung twisting may achieve temporary control. In these cases, total pneumonectomy is considered a last resort due to the associated mortality rates that reach 75-100% in most series [7,8]. The main reasons for a patient's death are uncontrolled bleeding, appearance of the death triad and the rapid development of fulminant right heart failure unresponsive to medical therapy [9].…”