Background: Acute necrotizing lung infections do not warrant surgical resection due to unclarified indications and high risks.
Objective: To review results of resection in the setting of acute necrotizing lung infections.
Methods: A retrospective review of 25 patients who underwent parenchymal resection since January, 2017 to may, 2017 for management of necrotizing pneumonia or lung gangrene.
Results: Twenty-five patients underwent resection for lung necrosis. At the time of consultation, all patients presented with pulmonary sepsis (all), empyema (n=7), hemoptysis (n=6), air leak (n=8), septic shock requiring pressors (n=6) and inability to oxygenate adequately (n=8). Each patient has been performed with either lobectomy (n=9), pneumonectomy (n=3, two were on right-sided), wedge resection (n=3), segmentectomy (n=4), or debridement (n=6). Most common microorganisms responsible for lung infection were Streptococcus pneumoniae and Staphylococcus aureus (total 14 of 25 patients) as identified using culture. Fourteen patients were ventilated preoperatively. The operations were performed via posterolateral thoracotomy in 18 cases and anterolateral thoracotomy in seven cases. There were two (8%) postoperative deaths. All patients not ventilated preoperatively were weaned from ventilatory support within three days.
Conclusions: In patients with necrotizing lung infections who are failing medical therapy, parenchymal resection, from debridement to pneumonectomy, is an effective possibility.