Noninvasive Positive Pressure Ventilation against Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty

Abstract

A 69-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) was on amblatory oxygen inhalation therapy (3 L/min) and scheduled for percutaneous transluminal pulmonary angioplasty (PTPA). The patient's New York Heart Association functional status was class III with recent worsening of dyspnea and apparent leg edema. Transthoracic echocardiography revealed right ventricular enlargement with mean pulmonary artery pressure of 42 mmHg. After PTPA, he was complicated with postoperative reperfusion pulmonary edema, and noninvasive positive pressure ventilation (NPPV) was applied immediately. Hypoxemia was successfully treated with 15 days of NPPV. Although mean pulmonary artery pressure was unchanged, his brain natriuretic peptide level decreased from preoperative 390.3 to postoperative 44.3 pg/dL. In addition, total pulmonary resistance decreased from preoperative 18 to postoperative 9.6 wood unit·m2. The patient was discharged on day 25 with SpO2 of 95% on 5 L/min of oxygen inhalation. Because pulmonary edema is a postsurgical life-threatening complication following PTPA, application of NPPV should be considered.

Inflammatory response and pneumocyte apoptosis during lung ischemia–reperfusion injury in an experimental pulmonary thromboembolism model

“…Apoptosis was determined by TUNEL in this study. Studies indicated that RPE clinical manifestations after interventions for PTE are similar to those of lung transplantation [ 5 – 8 ]. A significant number of pneumocytes undergo apoptosis after reperfusion in the transplanted rat lung [ 33 ].…”

“…Currently, pulmonary thromboembolism (PTE) is the third most common cause of death in hospitalized patients [ 1 ]. After PTE treatment such as thrombolytic therapy, pulmonary embolectomy, pulmonary suction thrombectomy [ 2 – 4 ], or alternative interventional strategy of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH) [ 5 ], lung ischemia–reperfusion injury (LIRI) may occur in the region of the affected lung.…”

Beneficial effects of inhaled NO on apoptotic pneumocytes in pulmonary thromboembolism model

“…Necrosis is a form of irreversible cell death accompanied by the loss of cell membrane integrity and ion pump damage. The clinical manifestations of RPE occurring after interventions for PTE are similar to RPE after lung transplantation [ 5 - 8 ]. Of particular importance after lung transplantation is severe life-threatening graft dysfunction that occurs in up to 30% of patients; this is related to LIRI [ 36 ].…”

“…Lung ischemia–reperfusion injury (LIRI) may occur in the region of the affected lung after the thrombolytic therapy, pulmonary embolectomy, pulmonary suction thrombectomy [ 2 - 4 ], or the alternative interventional strategy of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH) [ 5 ].Clinically, LIRI is characterized by reperfusion pulmonary edema (RPE) developing within 48 h post-operation (e.g., thromboendarterectomy, lung transplant, etc.). The patients are subjected to prolonged intubation for mechanical ventilation, ventilator-associated infections, longer stays in the intensive care unit (ICU), and early postoperative mortality [ 6 - 8 ].…”

High-Flow Nasal Cannula Therapy in a Patient with Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty

“…Noninvasive ventilation is a technique to augment alveolar ventilation delivered by face mask, without endotracheal intubation. We previously reported a patient with postsurgical reperfusion pulmonary edema following PTPA [ 8 ]. This patient accepted a long duration of 16 days of noninvasive ventilation.…”