Management of Pulmonary Parenchymal Injury

Question 1

when chest tube not required ?

Answer 1

occupies less than 10% to 20% of the chest cavity or measures < 2 cm in an asymptomatic patient

Question 2

Complications of TT

Answer 2

Vascular injuries, most commonly the intercostal artery or vein > require suture ligation, IR embolization, or thoracotomy to resolve.

rare injuries to the heart, lung parenchyma, diaphragm, or intraabdominal organs (stomach, spleen, liver, colon, other)

pleural shock (exceedingly rare vagal reflex resulting in cardiac arrest after reexpansion that should be treated with cardiopulmonary resuscitation algorithms)

expansion edema, wrong side placement, fistulas including bronchopleural/ chyle, empyema, pneumonia, and pain.

Question 3

urgent or delayed thoracotomy

Answer 3

posterolateral incision , give better exposure for pulmonary injuries.

anesthesia intubate with a dual-lumen tube
patient positioned with a bean bag in lateral decubitus with arms extended anteriorly and supported 90 degrees at the shoulder
A posterolateral thoracotomy at the fifth intercostal space should be made and a rib spreader placed.

Question 4

In a patient with a persistent air leak and an injury amenable to suture repair

Answer 4

-large horizontal mattress and pledgeted sutures can be used to approximate the tissue.
-stapled wedge resection may be performed
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Question 5

what is tractotomy

Answer 5

Tractotomy opens the lung parenchyma along the tract of the injury to allow for better exposure of the bleeding vessel, which can then be directly oversewn with a 3-0 polypropylene suture

a second suture can be used to close the tractotomy after bleeding has been controlled.

Question 6

If hilar bleeding is encountered after entering the chest

Answer 6

hilar control should be obtained by placing a large clamp across the hilum or dividing the pulmonary ligament up to the pulmonary vein and then twisting the Lung

Question 7

If both lung and artery are injured

Answer 7

pneumonectomy may be indicated

Question 8

Post Pnemonectomy mortality ?

Answer 8

Mortality 50 to 100 %
Death occurs due to acute right heart failure. Extracorporeal membrane oxygenation (ECMO) may be considered