Standardized Management of Acute Pulmonary Hemorrhage after Percutaneous Pulmonary Vein Intervention  

作　　者：Catalina Vargas-Acevedo Gareth J.Morgan Rhynn Soderstrom Richard Ing Nicholas Houska Jenny E.Zablah 

机构地区：[1]Department of Pediatric Cardiology,University of Colorado,The Heart Institute,Children’s Hospital Colorado,Aurora,CO 80045,USA [2]Department of Pharmacology,Children’s Hospital Colorado,Aurora,CO 80045,USA [3]Department of Anesthesia,University of Colorado,Children’s Hospital Colorado,Aurora,CO 80045,USA

出　　处：《Congenital Heart Disease》2024年第4期389-397,共9页先天性心脏病（英文）

摘　　要：Introduction:Pulmonary hemorrhage(PHm)is a life-threatening complication that can occur after catheter-based interventions in patients with pulmonary vein stenosis(PVS).Inhaled racemic epinephrine(iRE)and tra-nexamic acid(iTXA)have been used in other conditions,but a standardized approach in PVS has not been described.We aimed to describe the current management of PHm after PVS catheter-based interventions.Methods:We present a retrospective review of episodes of PHm from July 2022 to February 2024.PHm was defined as frank blood suctioned from the endotracheal tube including blood-tinged secretions and>3%decrease in saturations and/or ventilatory changes with or without acute chest X-ray changes.Each individual episode of PHm was considered a separate event.Incidence was calculated based on the total number of PVS interventions during the study period.Results:Eleven episodes of PHm were identified out of 108 PVS interventions,resulting in an incidence of 10.2%.Five(45.5%)had primary PVS,and seven(63.6%)had bilateral PVS.The median age at PHm was 23 months(3-91 months).Four episodes were treated with iRE,five with both iRE and iTXA,and two with only iTXA due to a history of suprasystemic right ventricular pressures.Median time on mechanical ventila-tion after PHm was 24 h(15-72 h)and a median ICU stay of 2 days(1-8 days).Hemostasis was achieved in all events.There were no adverse events after iTXA,however,transient hypertension was observed after iRE which was dose-related.Conclusions:The implementation of a standardized protocol for the treatment of PHm in PVS has the potential to improve procedural planning,has a wider availability of medications,and greater awareness by the providers involved,possibly leading to earlier detection of PHm and appropriate treatment.

关 键 词：Pulmonary vein stenosis congenital heart disease pulmonary hemorrhage inhaled tranexamic acid racemic epinephrine 

分 类 号：R563.6[医药卫生—呼吸系统]