title: [Recruitment maneuver and high PEEP in a patient with severe reperfusion pulmonary edema after pulmonary thromboendarterectomy].
abstract: Recently open lung approach such as recruitment maneuver and high PEEP has been applied in patients with acute respiratory distress syndrome. We report here a 29-year-old man with chronic pulmonary thromboembolism (CPTE). In this case, recruitment maneuver and high PEEP relieved postoperative respiratory failure. The major complications after pulmonary thromboendarterectomy (PTE) for CPTE are: reperfusion pulmonary edema (RPE), pulmonary hypertension (PH), hypoxia and bronchial bleeding, all of which the patient has demonstrated. Preoperative examination showed high pulmonary artery pressure (85/41, mean 50 mmHg), and high pulmonary vascular resistance predicted poor postoperative course. After PTE, he developed severe RPE, PH, hypoxia and bronchial bleeding, resulting in failed weaning from cardiopulmonary bypass. Therefore he required mechanical support of percutaneous cardiopulmonary support (PCPS). In ICU we repeated recruitment maneuver (PEEP: 30 cmH2O, peak inspiratory pressure: 42 cmH2O, respiratory rate; 15 breaths.min-1, for 1 min) and kept high PEEP (15 cmH2O). After initiating this ventilatory strategy, RPE was gradually relieved, followed by improvement of oxygenation and PH. We successfully weaned him from PCPS 38 hr after surgery and he was discharged alive on the 90 post-operative day. We conclude that recruitment maneuver and high PEEP may be useful for RPE developed after PTE.
authors.affiliation: Department of Surgical Intensive Care Unit, National Cardiovascular Center, Suita 565-8565.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Tachibana
authors.forename: Hideaki
authors.initials: H
authors.lastname: Imanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyano
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Keiji
authors.initials: K
authors.lastname: Kumon
authors.forename: Motomi
authors.initials: M
authors.lastname: Ando
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogino
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004691:Endarterectomy; D006801:Humans; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy*; D011654:Pulmonary Edema / Q000628:therapy*; D011655:Pulmonary Embolism / Q000601:surgery*; D015427:Reperfusion Injury / Q000628:therapy*; D012720:Severity of Illness Index