Catheter-induced delayed recurrent pulmonary artery hemorrhage. Intervention with therapeutic embolism of the pulmonary artery

INTRODUCTION of the flow-directed, balloon-tipped catheter by Swan et al1in 1970 has facilitated bedside hemodynamic monitoring in the critically ill patient. Although this catheter usually allows safe measurement of important hemodynamic variables, it is not without morbidity.2,3 Pulmonary artery hemorrhage is a relatively rare but often catastrophic complication of pulmonary artery catheterization. The literature reports an incidence of 0.06% to 0.2%,4,5with a mortality ranging from 45% to 65%.6-8Survivors, on rare occasion, exhibit delayed hemorrhage after stabilization from the initial bleeding episode. Only five cases of delayed recurrent pulmonary artery hemorrhage have been reported,8-12with a delay of 33 hours to 7 months. Three of these patients survived; two required thoracotomy,9,12and the other received therapeutic embolism to a false aneurysm of the pulmonary artery.10Presented are three additional patients who suffered recurrent delayed pulmonary hemorrhage secondary to balloon-tipped catheters, one