Winch Peter D, Tumin Dmitry, Moore Jeffrey, Vizzini Samantha J, Berman Darren P, Naguib Aymen N
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, 43205, USA.
Department of Cardiology, Toledo Children's Heart Center, Toledo, USA.
Pediatr Cardiol. 2018 Aug;39(6):1236-1241. doi: 10.1007/s00246-018-1888-6. Epub 2018 May 9.
Recent advances in the field of pediatric interventional cardiology have resulted in therapies for patients in need of augmented pulmonary artery (PA) flow. Catheter-based PA rehabilitation can be performed safely but not without the potential risk of pulmonary hemorrhage. When severe, this bleeding has the ability to contaminate the bronchi and trachea, and possibly occlude the endotracheal tube. This can result in a critical inability to ventilate and oxygenate these patients. Herein, we review our institutional experience with pulmonary hemorrhage associated with these procedures and the feasibility of predicting this outcome. The secondary aim was to discuss our novel anesthetic approach to a select group of these patients, involving the use of bronchial blockers to preemptively prevent contamination of bilateral bronchi and occlusion of the endotracheal tube.
