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The Annals of Thoracic Surgery, Vol 30, 281-284, Copyright © 1980 by The Society of Thoracic Surgeons
PA Ilabaca, JL Ochsner and NL Mills
This prospective study involves 406 consecutive adults who had heart
operation with extracorporeal circulation. Fifteen patients (3.7%) bled at
the rate of 200 ml per hour or more in the postoperative period. Thirteen
of the 15 patients who bled had undergone coronary artery operation. After
all clotting factors and, when applicable, hypertension had been checked
and corrected, positive end-expiratory pressure (PEEP) was used in managing
the bleeding of these patients. Before institution of PEEP, the average
bleeding was 330 ml per hour for one to five hours. After PEEP was
instituted in the 11 patients in whom bleeding was controlled, an average
output of 25 ml per hour for one to ten hours was recorded. Patients were
kept on PEEP for 5 to ten hours. In 7 patients hemorrhage was controlled
with 10 cm H2O of PEEP; 4 required 15 cm of PEEP to stop bleeding; 3 were
explored for continuous bleeding on 15 cm of PEEP; and 1 was explored
because of hypotension on 15 cm of PEEP. In 11 of the 15 patients who bled
postoperatively (73%), operation was avoided by judicious use of PEEP. We
believe that PEEP increases mediastinal pressure and that the overdistended
lung can obliterate some bleeding in the mediastinum, thus controlling
bleeding in many of these patients.
ARTICLES
Positive end-expiratory pressure in the management of the patient with a postoperative bleeding heart
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