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Management of intrapulmonary hemorrhage in patients undergoing pulmonary thrombo-endarterectomy


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

Correspondence Address:
Muralidhar Kanchi
Anaesthesia and Intensive Care, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore - 560 099, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_191_20

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Year : 2021  |  Volume : 24  |  Issue : 3  |  Page : 384-388

 

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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.






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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

Correspondence Address:
Muralidhar Kanchi
Anaesthesia and Intensive Care, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore - 560 099, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_191_20

Rights and Permissions

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.






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