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Ann Thorac Surg 1980;30:281-284
© 1980 The Society of Thoracic Surgeons

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Articles

Positive End-Expiratory Pressure in the Management of the Patient with a Postoperative Bleeding Heart

From the Department of Surgery, Ochsner Medical Institutions, New Orleans, LA

Accepted for publication February 25, 1980.

^* Address reprint requests to Dr. Ochsner, Ochsner Clinic, 1514 Jefferson Hwy, New Orleans, LA 70121

	Abstract

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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 five 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.

	References

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8. Powers SR, Mannal R, Neclerio M, et al. Physiologic consequences of positive end expiratory pressure (PEEP) ventilation Ann Surg 1973;178:265.[Medline]
9. Sugarman HJ, Rogers RM, Miller LD. Positive end-expiratory pressure (PEEP): indications and physiologic considerations Chest 1972;62:865.
10. Trimble AS, Herst R, Grady M, et al. Blood loss in open heart surgery Arch Surg 1966;93:323.[Medline]
11. Wright TA, Darte J, Mustard WT. Postoperative bleeding after extracorporeal circulation Can J Surg 1959;2:142.[Medline]

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ilabaca, P. A. Articles by Mills, N. L. Search for Related Content PubMed PubMed Citation Articles by Ilabaca, P. A. Articles by Mills, N. L.