Post pneumonectomy pulmonary oedema

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Karim,
 
In our San Diego County 20 + year, Trauma Registry we have very very few survivors of pnuemonectomy. Seems to cross a threshold of severity every time we do it. Lots of patients successfully managed with extensive partial lobectomy etc. as I'm sure you've experienced. We always predict death whenever we take out the entire lung. Pulmonary edema / severe ARDS seen in many patients and worsening often delayed during initial postop course.
Great question for the members of the list.
 
Mike Sise
San Diego 

________________________________

From: Mike Smertka [mailto:medic0947969 at yahoo.com]
Sent: Tue 2/12/2008 3:21 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Post pneumonectomy pulmonary oedema



Dr. Mattox,
  
  Is there anyhting on the market to inhibit the cytokne release. In my hasty google search all I found were experimental.
  
  Mike

KMATTOX at aol.com wrote:
  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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