2020 Volume 27 Issue 1 Pages 32-36
Intratracheal bleeding during extracorporeal surgery can be fatal. Inhaled nitric oxide (NO) selectively dilates healthy alveolar vessels, improves pulmonary vascular resistance and ventilatory blood flow ratio, and consequently improvement of oxygenation is expected. A 66-year-old man underwent total arch replacement for a thoracic aortic aneurysm. A large volume of bleeding was observed from the endotracheal tube immediately after withdrawal from extracorporeal circulation. Bleeding from the right bronchus, pulmonary artery injury was suspected due to the pulmonary artery catheter. Since the oxygenation failure and circulatory collapse were sustained, we inserted extracorporeal membrane oxygenation (ECMO) and returned the patient to the ICU. Improvement in oxygenation performance was poor, and inhaled NO was initiated 3 days after surgery. Improvement of oxygenation and decrease of pulmonary artery pressure were observed, which allowed withdrawal from the ECMO and removal from the ventilator. Inhaled NO was effective in improving hypoxemia after endotracheal hemorrhage.
