Novel Bronchoscopic Management of Airway Bleeding With Absorbable Gelatin and Thrombin Slurry

Abstract

Bronchoscopic instillation of an absorbable GTS is feasible and may be used in cases of spontaneous or procedure-related bleeding in addition to conventional measures. It can be delivered through the working channel of the bronchoscope or through the distal port available in some bronchial blockers. Controlled studies are necessary to determine the safety and efficacy of this novel technique.

Managing Massive Hemoptysis

“…Other techniques of local hemoptysis control using substrates to promote hemostasis or tamponade including oxidized regenerated cellulose, gelatinthrombin, silicone spigots, airway stents, and polymer surgical sealants have been described. 53,[56][57][58][59][60] Tranexamic acid (TXA), an antifibrinolytic medication that competitively inhibits plasminogen activation, has been prospectively studied in groups of submassive hemoptysis in both IV and nebulized form. Although patients with massive hemoptysis were not included, TXA was associated with a decrease in hemoptysis and need for interventional procedures.…”

Oncologic Emergencies—The Old, the New, and the Deadly

“…Additionally, central endoluminal lesions can be controlled with topical vasoconstriction, thermal, or direct cautery. 39 Independent predictors of mortality in patients with massive hemoptysis include chronic alcoholism, neoplasm, mechanical ventilation, multilobar infiltrates, and pulmonary vascular involvement. 40 Conversely, diffuse alveolar hemorrhage (DAH) encompasses a variety of disorders in which significant bleeding occurs in the lungs, but not always with overt hemoptysis.…”

Successful use of an EZ-blocker for lung isolation and management in a hemoptysis patient

“…The first blocks the endobronchial lesions with packing material. Although the success rate is high, an expert physician and special instruments such as a rigid bronchoscope are required to perform packing in the context of massive hemoptysis, and the patient must survive until arrival in the operation room; packing cannot be performed in the intensive care unit or the emergency room (5,6). The second (more common) method is selective endobronchial blocking after intubation.…”