A systematic approach to the management of massive hemoptysis

Abstract

Massive hemoptysis is regarded as a potentially lethal condition that requires immediate attention, and prompt action. Although minor hemoptysis is frequently encountered by most clinicians, massive hemoptysis in far less frequent and most physicians are not prepared to manage this time-sensitive clinical presentation in a systematic and timely fashion. Critical initial steps in management need to be implemented in an expedited fashion, such that patients may have a chance at a more definitive treatment. In this article, we review the definition, vascular anatomy, etiology, diagnostic evaluation, epidemiology and prognostic markers of massive hemoptysis. A systematic approach to management, stabilization and treatment options is followed. An algorithm is proposed for the management of massive hemoptysis and the importance of a multidisciplinary approach is emphasized.

Managing Massive Hemoptysis

“…Although the timing of flexible bronchoscopy in the management of patients who are stable with minor hemoptysis remains controversial, among patients who are unstable, early bronchoscopy is preferred to localize hemorrhage, isolate bleeding with a bronchial blocker, or for selective intubation and evacuating blood from the airways. 11,44,48 Both CT scan and bronchoscopy are complementary in localization and diagnosis of hemoptysis. 38 In patients who are unstable where transfer is unsafe and intubation and lung isolation is of the utmost importance, flexible bronchoscopy is the procedure of choice and can be performed at the bedside, if available.…”

Acute life‐threatening massive haemoptysis in a patient with a predicted difficult airway and emphysematous lung disease

“…Acute life-threatening massive haemoptysis can be defined by expectorated volumes of 100 to 1000 ml in a 24-hour period, though pragmatically any haemorrhage over 100 ml yielding abnormal pulmonary gas exchange, airway obstruction or haemodynamic instability may qualify [1]. Whilst no specific guidelines exist, the optimal airway management in acute life-threatening massive haemoptysis is thought to involve either immediate rigid bronchoscopy or lung isolation and one-lung ventilation by placement of either a double-lumen tube or a bronchial blocker [2,3].…”

Multidisciplinary Management of Lung Destruction Presenting with Massive Hemoptysis and Asphyxia

“…The involved lung is nonfunctional, with demonstrable absent perfusion and ventilation and important sequela was always induced. The causes of destroyed lung include bronchiectasis, tuberculosis (TB), lung abscess, necrotic pneumonia, pulmonary infarction, fungal infection, bronchial stenosis, and congenital lung disease, of which the most common causes were bronchiectasis and TB [1,5,6].…”

“…Hemoptysis may also arise from nonbronchial systemic arteries (5%). Otherwise bleeding can coexist, or cannot be determined in some patients [1,2].…”

“…This complication is a life-threatening condition associated with a poor prognosis without prompt treatment. The initial management is resuscitation and protecting airway [1]. Prompt identification of its causes and location by CT and bronchscopy is mandatory to do an adequate treatment and to avoid fatal complications [2].…”