Nutrition management of a patient following emergent pneumonectomy due to chest wall trauma

Emergent total pneumonectomy is a rare surgical intervention for patients with severe chest trauma. Patients who survive the immediate postoperative period experience prolonged, complex hospitalizations. The purpose of this case study is to review the nutrition care provided to a patient who survived total pneumonectomy and the supporting evidence. John Doe (JD) is a man aged 28 years who presented to a level I trauma center with penetrating chest trauma. He required multiple operative interventions, resulting in a partial right and total left pneumonectomy. JD's hospitalization was complicated by prolonged use of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). His surgical course and gastric feeding intolerance hampered enteral nutrition adequacy, and parenteral nutrition support was initiated on hospital day 17. Tolerance to enteral nutrition improved after jejunal access was obtained, and the patient transitioned to total enteral nutrition support. As a result of inflammatory metabolic changes and nutrition delivery challenges for the first 2 weeks of hospitalization, JD developed malnutrition. His nutrition care was further complicated by copper and carnitine deficiencies, which have been described in patients requiring ECMO and CRRT. Patients who require emergent total pneumonectomy following traumatic chest injuries will likely require complex hospital care, including extracorporeal organ support. These patients present unique nutrition challenges; however, given the relative infrequency of the intervention, there is limited research to guide clinical practice. Additional research on nutrition interventions in this population is warranted.