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Massive Hemoptysis

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Evidence-Based Critical Care

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Abstract

Massive hemoptysis occurs in up to 10 % of hemoptysis requiring hospital admission, and is associated with significant morbidity and mortality. Risk factors have been recognized to aid in identification of patients at highest risk of mortality. The initial volume of bleeding, respiratory compromise and hemodynamic status should dictate the diagnostic and treatment approach. An ABC (Airway, Blood loss, and Clinical features) mnemonic can assist with rapid assessment of the unstable patient. Based on the initial survey, one considers decisions of airway protection; isolating the affected lung; ICU transfer; radiographic and bronchoscopic evaluation; and interventional radiographic, bronchoscopic and/or surgical treatment. We present an illustrative case of massive hemoptysis and a suggested approach to care.

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References

  1. Croco JA, Rooney JJ, Fankushen DS, DiBenedetto RJ, Lyons HA. Massive hemoptysis. Arch Intern Med. 1968;121:495–8.

    Article  Google Scholar 

  2. Fartoukh M, Khoshnood B, Parrot A, Khalil A, Carette M, Stoclin A, Mayaud C, Cadranel J, Ancel P. Early prediction of in-hospital mortality of patients with hemoptysis: an approach to defining severe hemoptysis. Respiration. 2012;83:106–14.

    Article  PubMed  Google Scholar 

  3. Dwelk RA, Stoller JK. Role of bronchoscopy in massive hemoptysis. Clin Chest Med. 1999;20:89–105.

    Article  Google Scholar 

  4. Ibrahim WH. Massive hemoptysis: the definition should be revised. Eur Respir J. 2008;32:1131–2.

    Article  CAS  PubMed  Google Scholar 

  5. Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med. 2000;28:1642–7.

    Article  CAS  PubMed  Google Scholar 

  6. Remy-Jardin M, Bouaziz N, Dumont P, Brillet P-Y, Remy J. Bronchial and non bronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography. Radiology. 2004;233:741–9.

    Article  PubMed  Google Scholar 

  7. Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics. 2002;22(6):1395–409.

    Article  PubMed  Google Scholar 

  8. Shamji MF, Maziak DE, Shamji FM, Ginsberg RJ, Pon R. Circulation of the spinal cord: an important consideration for thoracic surgeons. Ann Thorac Surg. 2003;76:315–21.

    Article  PubMed  Google Scholar 

  9. Khalil A, Fartoukh M, Tassart M, Parrot A, Marsault C, Carette MF. Role of MDCT in identification of the bleeding site and the vessels causing hemoptysis. Am J Roentgenol. 2007;188:117–25.

    Article  Google Scholar 

  10. Noe GD, Jaffe SM, Molan MP. CT and CT angiography in massive hemoptysis with emphasis on pre-embolization assessment. Clin Radiol. 2011;66:869–75.

    Article  CAS  PubMed  Google Scholar 

  11. Yoon YC, Lee KS, Jeong YJ, Shin SW, Chung MJ, Kwon OJ. Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT. Radiology. 2005;234:292–8.

    Article  PubMed  Google Scholar 

  12. Düpree HJ, Lewejohann JC, Gleiss J, Muhl E, Bruch HP. Fiberoptic bronchoscopy of intubated patients with life-threatening hemoptysis. World J Surg. 2001;25(1):104–7.

    Article  PubMed  Google Scholar 

  13. Cho AH, Khosla R. A case of massive airway clotting after use of activated factor VII for massive hemoptysis: management with flexible bronchoscopy and cryoadhesion. J Bronchol Interv Pulmonol. 2013;20(3):276–7.

    Article  Google Scholar 

  14. Lau EM, Yozghatlian V, Kosky C, Moriarty C, Dentice R, Waugh R, Torzillo PJ, Bye PT. Recombinant activated factor VII for massive hemoptysis in patients with cystic fibrosis. Chest. 2009;136(1):277–81.

    Article  CAS  PubMed  Google Scholar 

  15. Estella A, Jareño A, Perez-Bello Fontaiña L. Intrapulmonary administration of recombinant activated factor VII in diffuse alveolar hemorrhage: a report of two case stories. Cases J. 2008;1(1):150.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yildirim H, Ucgun I, Yalcin AU, Gulbaş Z, Sahin G, Acikalin MF, Metintas M, Ak G. Recombinant factor VIIa treatment for life-threatening haemoptysis. Respirology. 2006;11(5):652–4.

    Article  PubMed  Google Scholar 

  17. Moen CA, Burrell A, Dunnig J. Does tranexamic acid stop haemoptysis. Interact Cardiovasc Thoracic Surg. 2013;17(6):991–4.

    Article  Google Scholar 

  18. Binesh F, Samet M, Bovanlu TR. A case of pulmonary carcinoid tumour in a pregnant woman successfully treated with bronchoscopic (electrocautery) therapy. BMJ Case Rep. 2013.

    Google Scholar 

  19. Prutsky G, Domecq JP, Salazar CA, Accinelli R. Antifibrinolytic therapy to reduce hemoptysis from any cause. Cochrane Database Syst Rev. 2012:1–20.

    Google Scholar 

  20. Revel MP, Fournier LS, Hennebicque AS, Cuenod CA, Meyer G, Reynaud P, Frija G. Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis? Am J Roentgenol. 2002;179(5):1217–24.

    Article  Google Scholar 

  21. Morita Y, Takase K, Ichikawa H, Yamada T, Sato A, Higano S, Takahashi S. Bronchial artery anatomy: preoperative 3D simulation with multidetector CT. Radiology. 2010;255(3):934–43.

    Article  PubMed  Google Scholar 

  22. Sakr L, Dutau H. Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management. Respiration. 2010;80:38–58.

    Article  CAS  PubMed  Google Scholar 

  23. Larici AR, Franchi P, Occhipinti M, Contegiacomo A, del Ciello A, Calandriello L, Storto ML, Marano R, Bonomo L. Diagnosis and management of hemoptysis. Diagn Interv Radiol. 2014;20(4):299–309.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Haponik EF, Fein A, Chin R. Managing life-threatening hemoptysis: has anything really changed? Chest. 2000;118:1431–5.

    Article  CAS  PubMed  Google Scholar 

  25. Johnson JL. Manifestations of hemoptysis. How to manage minor, moderate, and massive bleeding. Postgrad Med. 2002;112(4):101–6. 108–109, 113.

    Article  PubMed  Google Scholar 

  26. Bahk JH, Lim YJ, Kim CS. Positioning of a double-lumen endobronchial tube without the aid of any instruments: an implication for emergency management. J Trauma. 2000;49(5):899–902.

    Article  CAS  PubMed  Google Scholar 

  27. Tüller C, Tüller D, Tamm M, Brutsche MH. Hemodynamic effects of endobronchial application of ornipressin versus terlipressin. Respiration. 2004;71(4):397–401.

    Article  PubMed  Google Scholar 

  28. de Gracia J, de la Rosa D, Catalán E, Alvarez A, Bravo C, Morell F. Use of endoscopic fibrinogen-thrombin in the treatment of severe hemoptysis. Respir Med. 2003;97(7):790–5.

    Article  PubMed  Google Scholar 

  29. Lorusso R, De Cicco G, Vizzardi E, Gelsomino S. Human fibrinogen/thrombin-coated collagen patch to control intraoperative severe pulmonary hemorrhage and air leakage after correction of a ruptured thoracic aortic aneurysm. Ann Thorac Surg. 2011;91(3):917–9.

    Article  PubMed  Google Scholar 

  30. Reddy C, Majid A, Michaud G, Feller-Kopman D, Eberhardt R, Herth F, Ernst A. Gas embolism following bronchoscopic argon plasma coagulation: a case series. Chest. 2008;134(5):1066–9.

    Article  PubMed  Google Scholar 

  31. Dalar L, Sökücü SN, Özdemir C, Büyükkale S, Altın S. Endobronchial argon plasma coagulation for treatment of dieulafoy disease. Respir Care. 2015;60(1):e11–3.

    Article  PubMed  Google Scholar 

  32. Ernst A, Anantham D. Update on interventional bronchoscopy for the thoracic radiologist. J Thorac Imaging. 2011;26(4):263–77.

    Article  PubMed  Google Scholar 

  33. Colchen A, Fischler M. Emergency interventional bronchoscopies. Rev Pneumol Clin. 2011;67(4):209–13.

    Article  CAS  PubMed  Google Scholar 

  34. Alexander GR. A retrospective review comparing treatment outcomes of emergency lung resection for massive hemoptysis with and without preoperative bronchial artery embolization. Eur J Cardiothoracic Surg. 2014;45:251–5.

    Article  Google Scholar 

  35. Harrison M, Cowan S, Cavarocchi N, Hirose H. Massive haemoptysis on veno-arterial extracorporeal membrane oxygenation. Eur J Cardiothorac Surg. 2012;42(3):587–9.

    Article  PubMed  Google Scholar 

  36. Ong TH, Eng P. Massive hemoptysis requiring intensive care. Intensive Care Med. 2003;29(2):317–20.

    Article  PubMed  Google Scholar 

  37. Ketai LH, Mohammed TL, Kirsch J, Kanne JP, Chung JH, Donnelly EF, Ginsburg ME, Heitkamp DE, Henry TS, Kazerooni EA, Lorenz JM, McComb BL, Ravenel JG, Saleh AG, Shah RD, Steiner RM, Suh RD, Expert Panel on Thoracic Imaging. ACR appropriateness criteria for hemoptysis. J Thorac Imaging. 2014;29(3):W19–22.

    Article  PubMed  Google Scholar 

  38. Kiral H, Evman S, Tezel C, Alpay L, Lacin T, Baysungur V, Yalcinkaya I. Pulmonary resection in the treatment of life-threatening hemoptysis. Ann Thorac Cardiovasc Surg. 2015;21:125–31.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Lin CS, Becker WH. Broncholith as a cause of fatal hemoptysis. JAMA. 1978;239(20):2153.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Pulmonary, Critical Care, Allergy & Immunology, Wake Forest University/Wake Forest Baptist Health, Winston-Salem, NC, USA

    Andrew M. Namen

  2. Pulmonary, Allergy and Critical Care Medicine, Wake Forest University/Wake Forest Baptist Health, Winston-Salem, NC, USA

    Norman E. Adair

  3. Department of Anesthesiology, Section of Critical Care, Wake Forest University/Wake Forest Baptist Health, Winston-Salem, NC, USA

    David L. Bowton

Authors
  1. Andrew M. Namen
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  2. Norman E. Adair
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  3. David L. Bowton
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Corresponding author

Correspondence to Andrew M. Namen .

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Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, USA

    Robert C. Hyzy

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© 2017 Springer International Publishing Switzerland

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Namen, A.M., Adair, N.E., Bowton, D.L. (2017). Massive Hemoptysis. In: Hyzy, R. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-43341-7_26

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  • DOI: https://doi.org/10.1007/978-3-319-43341-7_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43339-4

  • Online ISBN: 978-3-319-43341-7

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