Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Feb 6;19(1):30.
doi: 10.1186/s12890-019-0790-1.

Severe thoracic trauma caused left pneumonectomy complicated by right traumatic wet lung, reversed by extracorporeal membrane oxygenation support-a case report

Feng Yun Wang  1 , Bin Fang  1 , Zhi Hui Yu  1 , Jing Song Shao  1 , Wei Biao Wen  1 , Li Xin Zhou  2
Affiliations
Case Reports

Severe thoracic trauma caused left pneumonectomy complicated by right traumatic wet lung, reversed by extracorporeal membrane oxygenation support-a case report

Feng Yun Wang et al. BMC Pulm Med. .

Abstract

Background: Double lumen intubation and one-lung ventilation should be applied without delay in cases of traumatic main bronchial rupture. In most cases, when the patients' vital signs have been stabilized, the repair can be performed. However, when one-lung ventilation is complicated by traumatic wet lung, the mortality rate is likely to be much higher.

Case presentation: In this case, the patient experienced a left main bronchial rupture, bilateral traumatic wet lung, and acute respiratory distress syndrome (ARDS) because of severe thoracic trauma. Though the patient was treated with intubation and mechanical ventilation (MV), his oxygenation was still not stable. Thus, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was initiated; upon improvement of oxygenation, the patient received an exploratory thoracotomy. Unfortunately, the rupture proved to be irreparable, resulting in a total left pneumonectomy. As there was severe ARDS caused by trauma, ECMO and ultra-low tidal volume (VT) MV strategy (3 ml/kg) were utilized for lung protection post-op. ECMO was sustained up to the 10th day, and MV until the 20th day, post-operation. With the support of MV, ECMO and other comprehensive measures, the patient made a recovery.

Conclusion: V-V ECMO and ultra-low VT MV helped this thoracic trauma patient survive the lung edema period and prevented ventilator associated pneumonia (VAP). In extreme situations, with the support of ECMO, the tidal volume may be lowered to 3 ml/kg.

Keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; One lung ventilation; Thoracic trauma; Traumatic wet lung.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable (only standard care were performed).

Consent for publication

Patient gave consent for publication and consent for publication was written.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a was the x-ray taken on admission, there were bilateral pneumothorax, bilateral traumatic wet lung, and multiple rib fractures. b was the x-ray taken after ECMO was weaned, the condition of the right lung recovered significantly, edema and exudation alleviated; the left lung was removed
Fig. 2
Fig. 2
a, b and c were the thoracoscopic pictures taken during the surgery, there were severe edema and congestion in the local tissue; the rupture was shown from different angles, which was irregular and unable to be repaired. d was the entire left lung after resection, which was dark red, exhibited serious signs of edema and congestion
See this image and copyright information in PMC

References

    1. Klein Y, Cohn SM, Proctor KG. Lung contusion: pathophysiology and management. Curr Opin Anaesthesiol. 2002;15(1):65–68. doi: 10.1097/00001503-200202000-00010. - DOI - PubMed
    1. Lin WT, Su SY, Hsieh CF, Lai CC, Chao CM. Traumatic thoracic burst fracture associated with bronchial rupture. J Emerg Med. 2017;53(2):260–261. doi: 10.1016/j.jemermed.2017.04.024. - DOI - PubMed
    1. Kim HK, Jun JH, Lee HS, Choi YR, Chung MH. Left mainstem bronchial rupture during one-lung ventilation with Robertshaw double lumen endobronchial tube -a case report. Korean J Anesthesiol. 2010;59(Suppl):S21–S25. doi: 10.4097/kjae.2010.59.S.S21. - DOI - PMC - PubMed
    1. Haider T, Halat G, Heinz T, Hajdu S, Negrin LL. Thoracic trauma and acute respiratory distress syndrome in polytraumatized patients: a retrospective analysis. Minerva Anestesiol. 2017;83(10):1026–1033. - PubMed
    1. Karmy-Jones R, Jurkovich GJ, Shatz DV, Brundage S, Wall MJ, Jr, Engelhardt S, et al. Management of traumatic lung injury: a Western trauma association multicenter review. J Trauma. 2001;51(6):1049–1053. - PubMed

Publication types

MeSH terms