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Tue Apr 22 18:57:37 BST 2008

Thanks Juan, it is a team effort...and I am glad you found the PA normal - that confirms the fact - there is no pulmonary HTN after pneumonectomy as I know and if there was, it would actually be PROTECTIVE from pulmonary edema...as there would be less flow through the lungs and not more ! Pulmonary hypertension doesn;t cause pulmonary edema ! This is a common misconception - anyone correct me if I am wrong.

Ivan Hronek MD 
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
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----- Original Message ----
From: "Duchesne, Juan C" <jduchesn at tulane.edu>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>; "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, April 22, 2008 8:50:51 AM
Subject: RE: Traumatic Pneumonectomy

It was a team effort starting from the scene until today. There is no "me" or "I" in our trauma center, definitively agree Ivan.
POD 3 extubated PA pressures WNL......really surprise.......maybe age and good heart are a factor.........EF%55 with good contractility.........with negative fluid balance: 200cc/hour urine output..........very good recovery.
Going retrospectively he received minimal crystalloids.....as part of our DCR.........
Since we started this resuscitation protocol for patients in need of massive transfusion.......the only important difference is the amount of FFP given early in the OR with limitation of crystalloids...........this patient received less than 2 liters intra-op and remained awake and alert post op.........with beautiful CXR.......extubated with great lung mechanics and good heart.
Will keep updating
Thanks
juan
Juan C Duchesne MD, FACS, FCCP
Trauma and Critical Care Surgery Section
Surgical Hospital Center Director
Director Surgical Intensive Care Unit  
Louisiana ATLS / PHTLS State Faculty

Tulane University School of Medicine
1430 Tulane Ave., SL-22
New Orleans LA 70112-2699
Tel. 504-988-5111
Fax. 504-988-3683

________________________________

From: trauma-list-bounces at trauma.org on behalf of ivan hronek
Sent: Mon 4/21/2008 10:30 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Traumatic Pneumonectomy

Was it the trauma partner or was it the anesthesiologist who did the great job ?
No kidding, let us know if you do get pulmonary hypertension please. Most of the papers I've seen said it is more likely large TVs (tidal volume, not television) that causes the lung injury and pulmonary edema. I am also not so sure if decreasing the cardiac output and so the amount of blood flowing through the remaining lung..if it is the left lung it may be worse..perhaps..

Ivan Hronek MD

-----Original Message-----
From: Duchesne, Juan C  <jduchesn at tulane.edu>
Sent: Monday, April 21, 2008 7:34 PM
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>; Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Subject: Traumatic Pneumonectomy

Trauma Case:
Just recently one of our trauma partners did a pneumonectomy on a 18 year old male for GSW to hylum with intra-op use of 54 u PRBC, 52 FFP and 26 plts, 10 Cryoprecipitate with 1.2 L of crystalloids!
This is part of our Damage Control Resuscitation (DCR) at Charity Trauma Center.
What to expect?
1. place swanz and monitor pulmonary pressures......get flolan, NO in the room.....get ready for a bumpy road!
2. early trach, peg
3. Get DNR
4. DCR is voodoo!
5. extubate and transfer to floor in 5 days
juan
Juan C Duchesne MD, FACS, FCCP
Trauma and Critical Care Surgery Section
Surgical Hospital Center Director
Director Surgical Intensive Care Unit 
Louisiana ATLS / PHTLS State Faculty

Tulane University School of Medicine
1430 Tulane Ave., SL-22
New Orleans LA 70112-2699
Tel. 504-988-5111
Fax. 504-988-3683
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Post-Pneumonectomy pulmonary edema