Complex perioperative and anaesthesia management of a polytrauma patient with intrathoracic haemorrhage undergoing...

Severe blunt chest trauma is associated with significant morbidity and mortality, particularly when complicated by intrathoracic haemorrhage and delayed recognition of ongoing bleeding. Perioperative and anaesthetic management in these patients is complex, requiring advanced airway skills, meticulous hemodynamic control, and effective multidisciplinary coordination. We present the case of an 18-year-old male polytrauma patient following a road traffic accident who was transferred to a tertiary referral centre with bilateral haemothoraces and initial hemodynamic instability. Despite early chest drainage and transient stabilization, the patient developed persistent transfusion requirements and radiological evidence of evolving right lower lobe intraparenchymal haemorrhage. Surgical exploration was performed 27 h after admission, resulting in an emergency open right lower lobectomy. Anaesthetic management was challenging. Tracheal intubation with a left-sided double-lumen tube was achieved using videolaryngoscopy, allowing effective one-lung ventilation. Advanced hemodynamic monitoring, including the hypotension prediction index, bispectral index monitoring, and thromboelastometry-guided transfusion, was used to guide fluid therapy, vasopressor and inotropic support, and targeted administration of blood products, fibrinogen, and prothrombin complex concentrate. Postoperatively, the patient was managed in the intensive care unit and showed gradual clinical improvement. Transient postoperative liver enzyme elevation resolved without evidence of structural hepatic injury. The patient was extubated successfully, discharged from the ICU in stable condition, and remained clinically well during a 12-month follow-up period. This case emphasizes the importance of early recognition of occult thoracic bleeding and highlights the critical role of advanced anaesthetic management in emergency lung resection following severe chest trauma.