The changes in hematocrit during the intra and postoperative period were studied in 50 patients who underwent uncomplicated open-heart procedures and who did not receive blood or blood products during their hospital stay. Priming of the extracorporeal circuit and blood volume replacement postoperatively was done with crystalloid solutions exclusively. Mean preoperative hematocrit was 44% and dropped to 30.8% during the pump run. Lowest postoperative hematocrit was on the fourth day (mean: 29.3%) but it never went below 50% of the preoperative value. The percentage of the initial hematocrit was calculated for all patients at each time point and a median curve was constructed. Then, the curve of each patient was compared to this median curve. Patients with values below the median curve at one point at least had a larger amount of intra and postoperative fluid replacement than patients that stayed above the median at all times. We conclude that non-transfused open-heart surgical patients do not develop severe anemia and that changes in the hematocrit values can be predicted according to the median curve constructed and to the amount of crystalloid solution given during and after surgery.

Adolescent↗

PubMedDate not supplied

[Massive endobronchial hemorrhage due to pulmonary artery rupture caused by a Swan-Ganz catheter].

We present the case of a 69-year-old male bearing a Swan-Ganz catheter while undergoing aortic and mitral valve replacement. Massive hemorrhage through the endotracheal tube began after closure of the sternotomy. Selective endobronchial intubation was performed and the thorax immediately reopened to reveal a tear in the right pulmonary artery at the level of the middle lobar branch. The tear was sutured, and throughout the early postoperative hours the patient presented signs of active bleeding through thoracic drains, with persistent slight hemoptysis in the right branch of the endotracheal tube. Ventilation was controlled artificially with two synchronized respirators and positive end-expiratory pressure (PEEP) up to 10 cm H2O in the right lung. The double-lumen tube was removed after 15 days with no complications and the patient was released two months after surgery. Massive endobronchial hemorrhage resulting from perforation of the pulmonary artery or its tributaries caused by Swan-Ganz catheters requires early diagnosis and treatment based on airway protection and immediate location and control of the point of hemorrhage. Selective endobronchial intubation with double-lumen tubes, direct arterial surgery and use of PEEP may constitute a valid alternative for management of these patients, making resection unnecessary.

Aged↗