Management of acute necrotizing lung infections: The role of surgery

Abstract

Background: There has been an increasing role of surgical intervention in managing patients with acute necrotizing lung infections and their complications, such as lung abscess and lung gangrene. Patients and Methods: In this retrospective study, conducted between 2003 and 2013, we presented patients of acute necrotizing pneumonia (ANP) and its complications, who required surgical interventions. Results: Twenty five patients required surgical management of their ANP. At the time of referral to cardiothoracic surgery all patients had evidence of ongoing sepsis despite the antibiotic therapy or have already developed complications. Patients presented with; persistent fever (n=18), cough with or without expectoration (n=25), hemoptysis (n=8), empyema (n=8), persistent air leak (n=3), severe hypoxia (n=3), septic shock (n=2), cachexia (n=6), leucocytosis (n=19), severe leuckopenia (n=3) and severe anemia (n=6). All patients were initially managed by internists, pneumologists and infectious disease teams for periods ranging from 1- 6 weeks prior to referral to cardiothoracic surgery. These patients required one or more of the following surgical procedures; anatomical lung resection (n=10), nonanatomical lung resection & debridement (n=15), and other procedures (n=10). No pneumonectomies were done in our series. There was no intra-operative mortality and only one post-operative mortality in our series. Conclusion: Surgical intervention including major or limited lung resection, for unilateral necrotizing lung infections is a safe procedure for patients with persistent sepsis who are not responding adequately to medical therapy or who have already developed complications.