Application of positive end-expiratory pressure in a case with large laceration on the superior vena cava

Abstract

Iatrogenic injury is a difficult situation for a surgeon. Being successful in saving a patient at risk is the major concern in this situation. Once an iatrogenic injury to the superior vena cava (SVC) is found, increasing the intrathoracic pressure is theoretically able to overcome the venous pressure and to alleviate or even stop bleeding from injury. A 76-year-old female patient, who had suffered from end-stage diabetic nephropathy, developed tension hemothorax during insertion of the cuffed hemodialysis catheter. The successful course of resuscitation without emergent operation or endovascular repair is presented here.

Treatment of a central venous perforation caused by dialysis intubation using coils and cyanoacrylate glue: A case report

“…A total of 13 case reports on central venous perforation caused by dialysis catheterization published between 2007 and 2018 were reviewed (Table I) (2–9,11–15). Among them, 8 patients presented with hemothorax and HS (2,3,5,7,8,12–14), and 1 patient died despite rescue after surgery (3).…”

“…After central venous perforation, the procedure for dealing with angiorrhexis to prevent further bleeding is a problem that requires to be considered. As presented in Table I, among the 13 cases reported from 2007 to 2018, 4 cases underwent thoracotomy (2–5), 1 case underwent thoracoscopic surgery (6), 3 cases received covered stents (7–9), 1 case received coil embolization (11), 3 cases received conservative treatment (12–14) and 1 case received coil combined with gel embolization (15). Of all of the cases, one patient died after thoracotomy (3).…”

The effect of postoperative positive end-expiratory pressure on postoperative bleeding after off-pump coronary artery bypass grafting

“…A chest-tube system allows drainage and provides a window to outside of the thorax and enables the monitoring of bleeding. Strategies have been devised in the preoperative, intraoperative, and postoperative periods to reduce bleeding, including the use of PEEP, which has been used for decades as an adjunct to ventilator therapy to improve oxygenation [1, 14, 16, 17]. The main aim and benefits of the PEEP ventilation mode are to improve pulmonary functions, and increase arterial and peripheral tissue oxygenation [23].…”

“…In our routine practice, we use a PEEP level of 5 cm H 2 O in patients after CABG at the intensive care unit during mechanical ventilation. However, increased PEEP levels may further prevent bleeding from internal thoracic artery beds by the tamponade effect [1, 16, 17]. …”