Management of intrapulmonary hemorrhage in patients undergoing pulmonary thrombo-endarterectomy

Massive pulmonary hemorrhage during pulmonary thromboendarterectomy (PTE) can be managed by a conservative approach with mechanical ventilatory support, positive end-expiratory pressure, lung isolation, reversal of heparin, and correct of coagulopathy. We present three challenging cases that develop...

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Bibliographic Details
Published in:Annals of cardiac anaesthesia 2021-07, Vol.24 (3), p.384-388
Main Authors: Kanchi, Muralidhar, Nair, Hema, Natarajan, Pooja, Punnen, Julius, Shetty, Varun, Patangi, Sanjay, Shetty, Deviprasad, Belani, Kumar
Format: Article
Language:English
Subjects:
Atracurium
Case Report
chronic thromboembolic pulmonary hypertension
cteph
Hemorrhage
pte
pulmonary hemorrhage
pulmonary thromboendarterectomy
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Summary:Massive pulmonary hemorrhage during pulmonary thromboendarterectomy (PTE) can be managed by a conservative approach with mechanical ventilatory support, positive end-expiratory pressure, lung isolation, reversal of heparin, and correct of coagulopathy. We present three challenging cases that developed intrapulmonary hemorrhage during/after PTE and managed successfully. The first patient had bleeding from the bronchial artery and right internal mammary collaterals, which was managed by coil-embolization. The second patient had a breach in the blood airway barrier in the right upper lobar segment of the lung, and the repair was done using a surgical absorbable hemostat. The third patient developed reperfusion injury, he was instituted on veno-venous extracorporeal membranous oxygenation, a week later, the patient recovered completely. An algorithm was adopted and modified to our requirements; all the 3 challenging intrapulmonary hemorrhage cases were successfully managed. This algorithm can be used for satisfactory outcomes in patients who suffer intrapulmonary hemorrhage during PTE.
ISSN:0971-9784
0974-5181
DOI:10.4103/aca.ACA_191_20