Parallel Technique of Endobronchial Balloon Catheter Tamponade for Transient Alleviation of Massive Hemoptysis

Abstract

Endobronchial balloon tamponade is an alternative method that can be used to control massive hemoptysis. Several different techniques have been used for this purpose. We describe a new parallel method, in which biopsy forceps introduced through a bronchoscope channel is used to grasp a balloon catheter. As the bronchoscope is advanced to the bleeding site, the balloon catheter is pulled into position, and subsequently inflated. There are several advantages of this technique. It needs no specialized catheter or guide wire, the procedure is relatively easy to perform, and applicable to other purposes such as introduction of an additional suction catheter. Fig. 5 presents the chest radiography after the procedure. The patient complained of intolerable throat pain four day after the catheter insertion. This discomfort subsided after removal of the catheters. There was no more hemoptysis after catheter removal and after 14 days the patient was transferred to the general ward. We recommended bronchial artery embolization but the patient and his family refused the procedure. The patient expired at 22 days after the procedure due to a recurrent sudden massive hemoptysis in spite of selective intubation and transfusion. DISCUSSIONSurgery for operable cases of massive hemoptysis has been reported to reduce the mortality to 18-23% (1, 2). This inter- Parallel Technique of Endobronchial Balloon Catheter Tamponade for Hemoptysis 825vention still has a high mortality and is not warranted for inoperable cases such as those with low lung reserve or other contraindicating medical problems. The results of bronchial artery embolization are often good. The initial success rate has been reported to be approximately 85% (3). However, this procedure requires a well-trained and experienced radiologist, because the bleeding vessels may originate not only from the bronchial artery but also from a nonbronchial systemic artery such as the intercostal or mammary arteries. Another complication of this technique is that the neurologic deficits may occur because some spinal arteries may arise from bronchial arteries (4).To decrease the mortality of massive hemoptysis, there should be a radical treatment followed by temporary blocking of bleeding and maintaining the patent airway with preserving lung tissue. But the single most important factor influencing mortality in massive hemoptysis is the rate of bleeding rather than the total amount of blood loss. Rapid flooding of the tracheobronchial tree causes the patient to drown in his own blood regardless of his age or the extent of underlying pulmonary disease (1). The primary objective for these patients should be prevention of asphyxia and exanguination.Endobronchial tamponade has been used as an alternative method for conservative management of massive hemoptysis (5). With previous techniques, the tamponade catheter has been introduced through the bronchoscope. The main challenge in performing this procedure is how to handle the distal cap of the balloon catheter. Several previous methods...

Covered Bronchial Stent Insertion to Manage Airway Obstruction with Hemoptysis Caused by Lung Cancer

“…In addition, they should be selectively intubated with a double-lumen endotracheal tube to prevent aspiration to the unaffected contralateral lung and preserve gas exchange. Endobronchial tamponade using a balloon tamponade catheter is an alternate site-specific therapy through the bronchoscopy ( 6 ).…”

Bronchoscopic Interventions in Patients With Hemoptysis

“…Bu durumda ya bu iş için özel tasarlanmış balon kateterleri kullanılmalı, ya da kateter bronkoskopa paralel gidecek şekilde dışarıdan kanama bölgesine ilerletilmelidir (1,20). Bunu kolaylaş-tırmak için çalışma kanalı içinden ilerletilen bir forseps yardımıyla kateterin ilgili bronşa ulaştırılması sağlana-bilir (22). Bu uygulama şekliyle sadece Fogarty kateteri değil, Swan-Ganz kateri veya diğer balon dilatasyon kateterleri de hemostaz amacıyla kanama bölgesine kolayca ulaştırılabilir.…”