Massive Pulmonary Hemorrhage: Surgical Approach as Choice of Treatment

Sehhat, Siavoush; Oreizie, Mahmoud; Moinedine, Khalil

doi:10.1016/s0003-4975(10)63478-9

Cited by 50 publications

(17 citation statements)

References 11 publications

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“…[15][16][17] Mortality rates in the adult series range from 11% to 85% with medical treatment, 9,[11][12][13][17][18][19][20][21] and from 0% to 50% with surgical treatment. 9,11,13,[17][18][19][20][21][22][23] Mortality rates in studies of children range from 0% to 32%. 4,6,12 The purpose of this study was to review 10 years of experience with hemoptysis in a tertiary pediatric hospital to identify patient characteristics and predictors of mortality.…”

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confidence: 99%

Hemoptysis: A 10-Year Retrospective Study

Coss‐Bu¹,

Sachdeva²,

Bricker³

et al. 1997

Pediatrics

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ABSTRACT. Background. Hemoptysis is uncommon in pediatric practice. We reviewed 10 years of experience with hemoptysis in a tertiary pediatric hospital to identify patient characteristics and predictors of mortality.Methods. Patients were divided into four age groups (0 to 5, 6 to 10, 11 to 20, and >20 years). Hemoptysis was defined as mild (<150 mL/day), large (150 to 400 mL/day), or massive (>400 mL/day). Fever was defined as 38.5°C.Results. A total of 228 patients (115 males and 113 females) with 246 episodes of hemoptysis were identified and grouped according to primary diagnosis. There were 149 patients in the cystic fibrosis (CF) group, 37 in the congenital heart disease (CHD) group, and 42 in the Other group. Age was significantly higher in the CF group compared with the CHD and Other groups. Length of stay was significantly prolonged in the CF group compared with the Other group. The overall mortality was 13%. After initial analysis, mortality predictors were age, amount of hemoptysis, receipt of blood products, and fever. After stratification, we found: 1) in the >20-year age group, there was a difference in mortality when comparing CF patients with CHD patients; 2) for patients who received blood products, there were differences in mortality in patients with CF, CHD, and Other diagnoses; 3) for patients who received blood, there were differences in mortality only for the 0-to 5-year age group; and 4) the amount of hemoptysis was predictive for mortality only in CHD patients.Conclusions. Hemoptysis presented in young adult CF patients and in adolescent CHD patients. Young adult CF patients with hemoptysis had a higher risk of mortality compared with young adult CHD patients.

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confidence: 99%

Hemoptysis: A 10-Year Retrospective Study

Coss‐Bu¹,

Sachdeva²,

Bricker³

et al. 1997

Pediatrics

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“…Localiza tion of the bleeding site may not be achieved during the first bronchoscopy and may require multiple evaluations, de pending on the clinical situation and rate of bleeding. Successful localization after repeat bronchoscopy has been reported in patients with massive [12,13,16,20] and nonmassive [2,6] hemoptysis of nonneoplastic origin. On the other hand, localiza tion was unsuccessful after serial bron choscopy in some patients in this and other series [2,3,9,12,13,16].…”

Section: Discussionmentioning

confidence: 99%

“…Successful localization after repeat bronchoscopy has been reported in patients with massive [12,13,16,20] and nonmassive [2,6] hemoptysis of nonneoplastic origin. On the other hand, localiza tion was unsuccessful after serial bron choscopy in some patients in this and other series [2,3,9,12,13,16]. Multiple factors may preclude adequate broncho scopie localization or evaluation: episodic hemorrhage of a focus in a peripheral air way or lung parenchyma; rapid mobiliza tion and expectoration of blood from the airways; or active bleeding that is too cop ious, diffuse (multiple sites), or flooding adjacent areas of normal lung.…”

Section: Discussionmentioning

confidence: 99%

Repeat Fiberoptic Bronchoscopy in Patients with Recurrent, Unexplained Hemoptysis

Gong¹

1983

Respiration

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Repeat fiberoptic bronchoscopy (FB) is indicated in patients with recurrent, unexplained hemoptysis to localize and/or diagnose the source of bleeding. The results of 34 bronchoscopies in 14 patients over a 6-year period were examined. 10 patients had 2 FBs each, 3 had 3 FBs each and 1 patient had 5 procedures at varying intervals. Only early FB detected active bleeding (12/25 early FBs) and localized a bleeding site (10/25). Definitive diagnoses (6/34 FBs) occurred only in patients with lung malignancy and were not necessarily influenced by the timing or frequency of FB. Clinical diagnoses and management were infrequently altered by each FB, except for management of malignancy. Thus, early, repeat FB in this diagnostically difficult group of patients contributes limited immediate information and minimally changes therapy in patients with nonneoplastic conditions. Despite these limitations, direct bronchial visualization by FB remains the most reliable standard available for localizing and, to a lesser extent, diagnosing the etiology of recurrent hemoptysis

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“…The many studies that have attempted to address the issues vary enormously in patient selection criteria and therefore are very difficult to compare (Table 4). Reported mortality rates for conservative nonsurgical management have ranged from as low as 18% [11] to a high of 85% [86]. The authors of all studies reporting low mortality in conservatively managed patients define massive hemoptysis at a relatively low level of 100 to 200 cc per 24 hours, and a minority of patients in these studies exceeded 600 cc of hemoptysis [8,11,19].…”

Section: Managementmentioning

confidence: 99%

“…The authors of all studies reporting low mortality in conservatively managed patients define massive hemoptysis at a relatively low level of 100 to 200 cc per 24 hours, and a minority of patients in these studies exceeded 600 cc of hemoptysis [8,11,19]. Reports showing high mortality without surgery have consistently defined massive hemoptysis at levels exceeding 600 cc in 24 to 48 hours [5,80,86]. The strong relationship between bleeding rate and mortality demonstrated by Crocco and associates [ 1 ], discussed earlier here, suggests the reason for the wide range of reported nonoperative mortality.…”

Section: Managementmentioning

confidence: 99%

Massive Hemoptysis: Pathogenesis and Management

Winter

Ingbar

1988

J Intensive Care Med

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Massive hemoptysis is a life-threatening complication of many pulmonary disorders, and it occurs most com monly in association with longstanding inactive tuber culosis, bronchiectasis, lung abscess, bronchogenic car cinoma, and fungal disease. It is generally a neovascular change or local erosive effect of chronic pulmonary dis ease and may originate from either bronchial or pulmo nary circulation. Recurrent bleeding is unpredictable; therefore, diagnostic and therapeutic intervention must be undertaken with urgency. The immediate priorities must be protection of the airway to the nonbleeding lung and localization of the site of hemorrhage prefera bly by bronchoscopy, which has a high yield when per formed during active hemorrhage. Immediate control of bleeding may be obtained by local tamponade with a balloon-tipped Fogarty catheter, use of a double-lumen endotracheal tube, or angiographically guided emboliza tion. Surgical resection is the preferred definitive treat ment for those who meet operative criteria; those who lack adequate pulmonary reserve are candidates for em bolization of sites with persistent bleeding. The high mortality of conservatively treated massive hemoptysis and the current inability to predict which patients will have fatal hemorrhage mandate rapid assessment and intervention.

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Massive Pulmonary Hemorrhage: Surgical Approach as Choice of Treatment

Cited by 50 publications

References 11 publications

Hemoptysis: A 10-Year Retrospective Study

Hemoptysis: A 10-Year Retrospective Study

Repeat Fiberoptic Bronchoscopy in Patients with Recurrent, Unexplained Hemoptysis

Massive Hemoptysis: Pathogenesis and Management

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