Bilateral Pneumonectomy saves a Sepsis Patient

Bilateral Pneumonectomy saves a Sepsis Patient

Melissa Benoit, 32 year old female, mother of 2 year old Olivia, developed Uncontrolled Sepsis as her End Stage Cystic Fibrosis worsened. Pulmonary infection was developing resistance to strongest of available antibiotics. The bacteremia was due to Pseudomonas aeruginosa, one of the most antibiotic resistant strain of bacteria. She was on the road to developing Multi Organ Dysfunction, a life threatening consequence of Sepsis. Sepsis is said to occurs whenever there is presumed or proven infection in patient with Systemic Inflammatory Response Syndrome (SIRS).

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The last resort available to the doctors’ knowledge was Bilateral Pneumonectomy while awaiting for transplantation. After discussing with their family members and obtaining consent, they started the procedure by opening her pericardium via Clampshell incision in the left aspect of chest. ECLS was maintained. Novalung (Xenios, Heilbronn, Germany), a portable artificial lung device was inserted between right pulmonary artery and left atrium. After completion of procedure, she was shifted to ICU where she showed dramatic signs of recovery. The donor for lung transplantation was obtained after six days. There was progressive improvement during the lung free period and the transplantation was successful and not accompanied with any kind of complications. After transplantation, there was excellent hemodynamic status. Currently she is fully mobile, clinically sound, breathing on room air.

This way, an aggressive procedure saves the life of a 32 year old mother who was dying from Sepsis with her bilateral fibrotic lungs.  The multidisciplinary team involved in the procedure included Thoracic surgeons, Pulmonologists and Critical Care specialists from Toronto General Hospital. In a case report they published on The Journal of Thoracic and Cardiovascular Surgery, they conclude that bilateral pneumonectomy could be a lifesaving procedure for patients with pulmonary-driven septic shock who are awaiting lung transplantation.

Respiratory system infections are the common source of Severe Sepsis accounting for about 40% of cases. Pseudomonas aeruginosa is isolated in about 19% of culture proven infections in patients with Severe Sepsis. Sepsis is one of the leading causes of death in critical care settings.


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REFERENCES

1.
Mayr F, Yende S, Angus D. Epidemiology of severe sepsis. Virulence. 2013;5(1):4-11.
2.
Cypel M, Waddell T, Singer LG, et al. Bilateral pneumonectomy to treat uncontrolled sepsis in a patient awaiting lung transplantation. T. 2017;153(4):e67-e69. doi:10.1016/j.jtcvs.2016.11.031