A Novel Treatment for Pulmonary Hemorrhage During Thromboendarterectomy Surgery

Shetty, Devi Prasad; Nair, Hema C; Shetty, Varun; Punnen, Julius

doi:10.1016/j.athoracsur.2014.11.060

Cited by 11 publications

(7 citation statements)

References 4 publications

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“…Although massive pulmonary hemorrhage is not common (prevalence of 0.5%-2%), it is a fatal complication of PEA operation (1) . Traditional methods, such as saline, protamine administration, fresh frozen plasma infusion, and high positive expiratory pressure (PEEP), are used to control hemorrhage, but in some cases, these methods may be insufficient (2) . Although intervention with bronchial blocker to control endobronchial hemorrhage has been used since the early 90s, pulmonary functions of the patient may not controlled at the CPB support discontinuation (3) .…”

Section: Discussionmentioning

confidence: 99%

Massive Pulmonary Hemorrhage Following Pulmonary Endarterectomy

Özgür¹,

Yanartaş²,

Taş³

et al. 2019

Kosuyolu Heart Journal

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Perioperative reperfusion injury, acute right heart failure, and massive pulmonary hemorrhage are the most important factors determining mortality following pulmonary endarterectomy operation (PEA). Our approach for the treatment of intraoperative pulmonary hemorrhage following pulmonary endarterectomy is discussed. We retrospectively studied a PEA case with massive pulmonary hemorrhage that occurred in 2017. We used endobronchial blocker to ensure that the bleeding is stopped and used extracorporeal membrane oxygenation (ECMO) for respiratory and hemodynamic requirements. ECMO is a good alternative for most of the pre-and postoperative major complications of PEA. Combined use of endobronchial blocker and ECMO could be a useful treatment method for massive pulmonary hemorrhage following pulmonary endarterectomy.

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Section: Discussionmentioning

confidence: 99%

Massive Pulmonary Hemorrhage Following Pulmonary Endarterectomy

Özgür¹,

Yanartaş²,

Taş³

et al. 2019

Kosuyolu Heart Journal

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“…The DLT may be placed initially without the use of a fiberoptic bronchoscopy and allows visualization via bronchoscopy afterwards ( 16 ). The DLT is more secure in the bronchus and permits a degree of suctioning to remove blood and clot from the airway but does not allow ready suctioning with an adult bronchoscope ( 5 , 16 ). The larger size of the DLT may predispose to vocal cord injury and is usually replaced by a single lumen ETT later in recovery ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

“…Additional techniques to help control pulmonary bleeding after endarterectomy include correction of coagulopathy, topical vasoconstrictors, and specific ventilator management, some suggesting the initial use of positive end expiratory pressure (PEEP) to help oxygenate and localize the source of bleeding ( 5 , 8 ). With our patients, various ventilation strategies were applied ranging from pressure control to ventilation control to a pressure limiting volume guaranteed mode with varying rates of success during the brisk hemorrhaging, as such ventilation likely plays a minor role in the immediate management of pulmonary hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary hemorrhage associated with PTE during the perioperative period is a rare, but life threatening complication ( 2 – 9 ). The management of such a complication has been discussed, but very little has been published on the appropriate techniques for airway management in the setting of hemorrhage associated with PTE ( 5 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Management of Pulmonary Hemorrhage Complicating Pulmonary Thromboendarterectomy

et al. 2018

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Airway management during pulmonary thromboendarterectomy (PTE) can prove challenging, especially in the face of unexpected intraoperative pulmonary hemorrhage. Utilization of proper airway equipment on induction is crucial for the successful management of intraoperative pulmonary hemorrhage. Our case series describes the preoperative risk factors that can lead to intraoperative pulmonary hemorrhage, the preinduction airway equipment considerations for PTE, and the intraoperative management of pulmonary hemorrhage. We summarize the lessons learned at our institution from four cases of post perfusion pulmonary hemorrhage.

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“…The surgeon suspected a breach in the blood airway barrier in the right upper lobar segment of the lung, hence repair was performed using a surgical absorbable hemostat (Surgicel ® , Ethicon, Johnson & Johnson, US). [ 7 ] Lung isolation was performed by exchanging ETT to a left-sided DLT and conservative management of bleeding was instituted. After the administration of protamine, bleeding via ETT abated.…”

Section: Case Reportmentioning

confidence: 99%