Survival after trauma pneumonectomy: the pathophysiologic balance of shock resuscitation with right heart failure.
Emergency pneumonectomy for trauma has a high mortality. Although exsanguination is a major factor leading to death, mortality remains high even after adequate resuscitation and is thought to be related to pulmonary edema and right heart failure. We present a series of nine patients who underwent pneumonectomy at Harbor-UCLA from penetrating (7) and blunt (2) trauma. Two patients survived; three initially survived the surgery but died postoperatively of hypoxemia and right heart failure; four died intraoperatively (2 from right heart failure and 2 from exsanguination). One survivor required open cardiac massage for asystole. Careful attention to prevent volume overloading before and during trauma pneumonectomy and maintaining a negative fluid balance postoperatively may contribute to survival in these patients.
Division of Cardiothoracic Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
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F
Baumgartner
B
B
Omari
J
J
Lee
M
M
Bleiweis
R
R
Snyder
J
J
Robertson
B
B
Sheppard
J
J
Milliken
D000293:Adolescent; D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012151:Resuscitation; D012774:Shock, Traumatic / Q000209:etiology / Q000628:therapy*; D013898:Thoracic Injuries / Q000150:complications* / Q000601:surgery*