Pathophysiology of Rupture of the Pulmonary Artery by Pulmonary Artery Balloon-Tipped Catheters

Abstract

of rupture of the pulmonary artery by pulmonary artery balloon-tipped catheters. Anesth Analg 1983;62:925-30. High pressures have been reported in pulmonary artery catheter balloons. This study was undertaken to determine the in vitro rupturing pressures of human peripheral pulmonary arteries and to evaluate whether such pressures could be generated under clinical conditions. The in vitro model then was confirmed in vivo in the dog and the evolution of a rupture of a peripheral pulmonary artery studied. In vitro, pulmonary arteries of subjects under age 60 yr are remarkably resistant and tolerate intra-balloon pressures of 2700 mm Hg in the one mid-pulmonary artery studied and up to 4219 k 720 mm Hg (mean 5 SD) in the distal pulmonary artery. Subjects over the age of 60 yr have significantly lower rupturing pressures (1965 * 540 mm Hg in the mid-pulmonary artery, and 2498 2 600 mrn Hg in the distal pulmonary artery), (P < 0.05). Thus overdistension by the balloon may explain most ruptures. Preexisting pulmonary hypertension did not affect in vitro rupturing pressures. Clinicians generated intraballoon mean pressures of 795 ? 130 mm Hg, with 20% of them generating higher and potentially dangerous pressures (1000 mm Hgor more). The in vitro model was confirmed by in vivo studies in dogs with pressures that cause pulmonary artery rupture. Furthermore, in normal dogs, rupture of a peripheral pulmonary artery was without complications. This suggests that rupture of the peripheral pulmonary artery may occur clinically more frequently than reported. The user of flotation pulmonary arterial catheters should be aware of the dangers associated with this diagnostic tool. In particular, liquids must never be used to inflate pulmonary arterial catheter balloons.

Extubation in Epiglottitis To the Editor

“…Our data (4) do not support this contention: with the catheters used in both studies, the pressure exerted on the PA wall at this particular moment of inflation would be approximately 200 torr (i.e., the opening pressure minus the pressure exerted by the elastic properties of the balloon, equivalent to postinflation pressure), a pressure well below PA rupturing pressures in our study. Our data (4) do not support this contention: with the catheters used in both studies, the pressure exerted on the PA wall at this particular moment of inflation would be approximately 200 torr (i.e., the opening pressure minus the pressure exerted by the elastic properties of the balloon, equivalent to postinflation pressure), a pressure well below PA rupturing pressures in our study.…”

Opacity over the left hemithorax after abdominal aortic aneurysm repair

“…Mechanisms of importance in catheter‐induced rupture are: perforation of the vessel with the catheter tip by a peripherally advanced catheter or by eccentric balloon inflation, damage of the vessel by withdrawal of a firmly wedged catheter or overdistention of the vessel [2, 4, 8, 9]. If pulmonary artery rupture is diagnosed both surgical and nonsurgical procedures, such as bronchoscopy with tamponade of the bleeding site using a Fogarty catheter, double lumen endotracheal intubation and 20 cmH 2 O positive end‐expiratory pressure (PEEP) ventilation are tested forms of treatment, with comparable results.…”

Usefulness of transesophageal echocardiography for guiding pulmonary artery catheter placement in the operating room

“…A catheter tip positioned too deeply is occasionally found postoperatively, possibly causing injury to the PA, a potentially fatal complication [3,4], or causing knot formation. These situations were encountered in five patients in our series.…”