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Endobronchial hemorrhage after intubation with double-lumen endotracheal tube in a patient with idiopathic thrombocytopenic purpura for minimally invasive cardiac surgery: a case report.

Kim HY, Baek SH, Kim KH, Kim NW - Korean J Anesthesiol (2014)

Bottom Line: In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube.Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count.Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea.

ABSTRACT
Minimally invasive cardiac surgery (MICS) requires lung isolation. Lung isolation is usually achieved with double-lumen endotracheal tube (DLT). Patients with idiopathic thrombocytopenic purpura (ITP) have an increased risk of bleeding events. We suspected endobronchial hemorrhage after exchange of DLT during induction of anesthesia for replacement of mitral valve in a 62-year-old man with a known ITP. The MICS was stopped and bronchial artery embolization was performed in the angiographic room. In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube. Lung isolation led to achievement of intermittent total lung deflation. Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count. Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray. (A) The chest X-ray shows total atelectasis of left lung after concluding the embolization of bilateral bronchial artery. There was no evidence of active bleeding, but blood clot was detected and removed using bronchoscope. (B) After the removal of blood clot, an improvement in lung collapse was observed.
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Figure 2: Chest X-ray. (A) The chest X-ray shows total atelectasis of left lung after concluding the embolization of bilateral bronchial artery. There was no evidence of active bleeding, but blood clot was detected and removed using bronchoscope. (B) After the removal of blood clot, an improvement in lung collapse was observed.

Mentions: Blood loss was estimated to be 150-200 ml over 30 min. Therefore, we suspected bronchial arterial injury; MICS was immediately stopped and bronchial artery embolization was scheduled in the angiographic room. Vital signs at that time, were blood pressure (BP) at 105/50 mmHg, heart rate (HR) at 115 beats/min, and SpO2 89%. During the transportation of the patient to the angiographic room, gradual decrease in the bleeding was noted, and the patient's vital signs in the angiographic room were stable (BP at 110-120/50-80 mmHg, HR 100 beats/min, and SpO2 99-100%). Angiography of the bronchial artery was performed, but focus of the bleeding was not found (Fig. 1). With reference to the risk of re-bleeding from the injured bronchial artery and the possibility of uncontrolled bleeding in patient with ITP, we decided to embolize the contributing bronchial arteries. After finishing the embolization of bilateral bronchial arteries, the chest X-ray was checked, and total atelectasis of left lung was observed (Fig. 2). There was no evidence of active bleeding, but blood clot was detected and removed using bronchoscope. After the removal of blood clot, an improvement in lung collapse was noted.


Endobronchial hemorrhage after intubation with double-lumen endotracheal tube in a patient with idiopathic thrombocytopenic purpura for minimally invasive cardiac surgery: a case report.

Kim HY, Baek SH, Kim KH, Kim NW - Korean J Anesthesiol (2014)

Chest X-ray. (A) The chest X-ray shows total atelectasis of left lung after concluding the embolization of bilateral bronchial artery. There was no evidence of active bleeding, but blood clot was detected and removed using bronchoscope. (B) After the removal of blood clot, an improvement in lung collapse was observed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927003&req=5

Figure 2: Chest X-ray. (A) The chest X-ray shows total atelectasis of left lung after concluding the embolization of bilateral bronchial artery. There was no evidence of active bleeding, but blood clot was detected and removed using bronchoscope. (B) After the removal of blood clot, an improvement in lung collapse was observed.
Mentions: Blood loss was estimated to be 150-200 ml over 30 min. Therefore, we suspected bronchial arterial injury; MICS was immediately stopped and bronchial artery embolization was scheduled in the angiographic room. Vital signs at that time, were blood pressure (BP) at 105/50 mmHg, heart rate (HR) at 115 beats/min, and SpO2 89%. During the transportation of the patient to the angiographic room, gradual decrease in the bleeding was noted, and the patient's vital signs in the angiographic room were stable (BP at 110-120/50-80 mmHg, HR 100 beats/min, and SpO2 99-100%). Angiography of the bronchial artery was performed, but focus of the bleeding was not found (Fig. 1). With reference to the risk of re-bleeding from the injured bronchial artery and the possibility of uncontrolled bleeding in patient with ITP, we decided to embolize the contributing bronchial arteries. After finishing the embolization of bilateral bronchial arteries, the chest X-ray was checked, and total atelectasis of left lung was observed (Fig. 2). There was no evidence of active bleeding, but blood clot was detected and removed using bronchoscope. After the removal of blood clot, an improvement in lung collapse was noted.

Bottom Line: In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube.Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count.Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea.

ABSTRACT
Minimally invasive cardiac surgery (MICS) requires lung isolation. Lung isolation is usually achieved with double-lumen endotracheal tube (DLT). Patients with idiopathic thrombocytopenic purpura (ITP) have an increased risk of bleeding events. We suspected endobronchial hemorrhage after exchange of DLT during induction of anesthesia for replacement of mitral valve in a 62-year-old man with a known ITP. The MICS was stopped and bronchial artery embolization was performed in the angiographic room. In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube. Lung isolation led to achievement of intermittent total lung deflation. Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count. Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure.

No MeSH data available.


Related in: MedlinePlus