Pulmonary Thromboendarterectomy - Recovery/ICU

Recovery/ICU

The ICU recovery involves several challenges. Some patients get significant reperfusion pulmonary edema, at places where thrombi were removed, and thus have less than ideal oxygen saturation values. This results because with the thrombus removal the surgeon strips out the pulmonary endothelium. The challenge for the ICU physician thus is getting the extra water out of the lungs, (for which they make use of the strong diuretic furosemide) to get decent oxygen saturation values, yet maintain the blood pressure. Maintaining these two parameters can be a challenge. Maintaining a good oxygen saturation can be accomplished by run the patient dry (with a diuretic) and set a high BiPAP (bidirectional positive airway pressure). Problem is that a high BiPAP leads to a poor venous return, which means the blood pressure suffers. Adding volume would help with the blood pressure, but would make the edema worse so it is generally avoided. Adding albumin does not help; the pulmonary arteries are too porous post-operation. So, a balancing act is required between blood pressure and oxygen saturation that is controlled with the BiPAP and the diuretic.