ABSTRACT
Extracorporeal membrane oxygenation has been used to treat refractory hypoxemia in numerous clinical scenarios. The fundamental principles for the management of massive hemoptysis patients include protecting the airway and healthy lung, locating the source of bleeding and controlling the hemorrhage. We report the case of a patient with acute respiratory failure associated with massive hemoptysis secondary to lung laceration during cardiac surgery. The use of extracorporeal membrane oxygenation allowed patient survival. However, due to the great difficulty in managing pulmonary clots after hemoptysis, it was necessary to use an unusual therapy involving endobronchial infusion of a thrombolytic agent as described in rare cases in the literature.
Subject(s)
Extracorporeal Membrane Oxygenation/methods , Fibrinolytic Agents/administration & dosage , Hemoptysis/therapy , Acute Disease , Cardiac Surgical Procedures/adverse effects , Female , Hemoptysis/etiology , Humans , Middle Aged , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapyABSTRACT
RESUMO A oxigenação por membrana extracorpórea tem sido utilizada para tratamento de hipoxemia refratária em muitos cenários clínicos. Os princípios fundamentais do manejo do paciente com hemoptise maciça são a proteção da via aérea e do pulmão sadio, a localização da fonte de sangramento e o controle da hemorragia. Relatamos o caso de uma paciente com insuficiência respiratória aguda associada à hemoptise maciça secundária à laceração pulmonar durante cirurgia cardíaca. O uso da oxigenação por membrana extracorpórea venoarterial permitiu a sobrevivência da paciente, porém, devido à grande dificuldade no manejo dos coágulos pulmonares após hemoptise, foi necessário o uso de terapia incomum, com infusão endobrônquica de trombolítico, conforme descrito em raros casos na literatura.
ABSTRACT Extracorporeal membrane oxygenation has been used to treat refractory hypoxemia in numerous clinical scenarios. The fundamental principles for the management of massive hemoptysis patients include protecting the airway and healthy lung, locating the source of bleeding and controlling the hemorrhage. We report the case of a patient with acute respiratory failure associated with massive hemoptysis secondary to lung laceration during cardiac surgery. The use of extracorporeal membrane oxygenation allowed patient survival. However, due to the great difficulty in managing pulmonary clots after hemoptysis, it was necessary to use an unusual therapy involving endobronchial infusion of a thrombolytic agent as described in rare cases in the literature.