Muralidhar Kanchi1, Hema C Nair1, Pooja Natarajan1, Julius Punnen2, Varun Shetty2, Sanjay Orathi Patangi1, Deviprasad Shetty2, Kumar Belani3
1 Department of Anaesthesiology and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
2 Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
3 Department of Anaesthesiology, University of Minnesota, Minneapolis, MN, United States of America
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.
Anaesthesia and Intensive Care, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore - 560 099, Karnataka
Source of Support: None, Conflict of Interest: None
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