Pulmonary artery perforation

Saturday August 19, 2006


Q: You have been called by the nurse at bedside as she noticed some fresh blood in ETT. Patient has pulmonary artery catheter (PAC) in place. You are worried about pulmonary artery perforation. What would be be your first response before you initiate whole 9 yards of workup and management?



A; "Get good lung up".

First thing you need to know which pulmonary artery (Right or Left) has distal end of PAC and get patient 's position change to lateral decub. with good lung up to avoid soiling of good lung.

If patient is on ventilator, other trick is to increase PEEP (literature is controversial about its efficacy but there is no harm in increasing PEEP to control catastrophy). Overall management is supportive if pulmonary artery perforation is confirmed. Actually it is better to leave PAC intact with ballon in inflated position !! Reversal of anticoagulation if needed, hemodynamic support and preventing good lung from soiling (like applying double lumen ETT) are the initial mainstay of treatment - followed by attempt to control bleeding with interventional radiology help.


Read article: Pulmonary Artery Rupture Induced by a Pulmonary Artery Catheter: A Case Report and Review of the Literature. Alexandre R. Abreu, MD, Michael A. Campos, MD and Bruce P. Krieger, MD Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida. Ref: Journal of Intensive Care Medicine, Vol. 19, No. 5, 291-296 (2004)