title: Successful management using airway pressure release ventilation for severe postoperative pulmonary edema.
abstract: BACKGROUND
  Postoperative pulmonary edema is a fatal adverse event after a cardiac surgery. We here report successful management using airway pressure release ventilation (APRV) for severe hypoxia with pulmonary edema after a cardiac surgery.
  
  
  METHODS
  A 58-year-old man underwent an uneventful mitral valve repair. Immediately afterwards, the patient became agitated and made vigorous inspiratory efforts. His oxygen saturation dropped to 90%. Coarse inspiratory rhonchi were heard on auscultation, and copious, pink, frothy sputum was obtained with suctioning. Initial chest radiograph showed right-sided patchy opacities and interstitial infiltrates. A transthoracic echocardiogram demonstrated normal cardiac function. With worsening respiratory failure on mechanical ventilation, APRV was attempted. His condition and blood gas was subsequently improved. Over the following 3days, the patient experienced an uneventful postoperative course and was discharged to home on postoperative day 14.
  
  
  CONCLUSIONS
  Extracorponeal membrane oxygenation (ECMO) is the most effective for severe hypoxia with pulmonary edema; however, ECMO is associated with hemorrhage and infectious complications. Alteratively, APRV was required for the successful management for severe hypoxia with pulmonary edema.
  
  
  CONCLUSIONS
  APRV could be effective for severe hypoxia with pulmonary edema after a cardiac surgery.
authors: Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan. Electronic address: yoshimor@gmail.com.
authors: Yoshihisa
authors: Y
authors: Morimoto
authors: Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan.
authors: Takaki
authors: T
authors: Sugimoto
authors: Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan.
authors: Hiroki
authors: H
authors: Arase
authors: Division of Cardiovascular Surgery, Awaji Medical Center, Hyogo, Japan.
authors: Fumiya
authors: F
authors: Haba
keywords: Airway pressure release ventilation (APRV); Extracorponeal membrane oxygenation (ECMO); Postoperative complication; Pulmonary edema; Severe hypoxia