Approach to Hemoptysis in the Modern Era

Gagnon, Simon; Quigley, Nicholas; Dutau, Hervé; Delage, Antoine; Fortin, Marc

doi:10.1155/2017/1565030

Cited by 57 publications

(65 citation statements)

References 111 publications

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“…44 For massive hemoptysis, intubation with larger diameter ETTs of $ 8.5 mm inner diameter is recommended when possible to enable passage of therapeutic flexible bronchoscopes with large working channels that allow extraction of obstructing blood clots and placement of bronchial blockers. 45 Several strategies for placement of inflatable bronchial blockers or Fogarty balloons either coaxially through an ETT or in parallel to the tube have been described ( Fig 1C). 32,46 In the absence of balloon occlusion, selective intubation into the left-or right-sided mainstem with an ETT can isolate the lung from hemorrhage on the contralateral side.…”

Section: Airway Stabilization and Isolation Of Hemorrhagementioning

confidence: 99%

Managing Massive Hemoptysis

Davidson

Shojaee

2020

Chest

151

109

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Section: Airway Stabilization and Isolation Of Hemorrhagementioning

confidence: 99%

Managing Massive Hemoptysis

Davidson

Shojaee

2020

Chest

151

109

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“…Minor bleeding was de ned as bleeding control by means of segmental wedging and/or topical administration of cold saline or adrenaline, whereas major bleeding required an additional hemostatic agent (e.g. oxidized regenerated cellulose [ORC] mesh), pulmonary isolation (using selective endobronchial intubation, a bronchus blocker or a double-lumen tube), bronchial artery embolization or surgery [11].…”

Section: Data Collectionmentioning

confidence: 99%

Diagnostic Yield, Safety and Impact of Transbronchial Lung Biopsy in Mechanically Ventilated Critically Ill Patients: A Retrospective Study

Ghiani

Neurohr

2020

Preprint

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BackgroundPulmonary infiltrates of variable etiology are one of the main reasons for hypoxemic respiratory failure leading to invasive mechanical ventilation. If pulmonary infiltrates remain unexplained or progress despite treatment, the histopathological result of a lung biopsy could have significant impact on change in therapy. Surgical lung biopsy is the commonly used technique, but due to its considerable morbidity and mortality, less invasive bronchoscopic transbronchial lung biopsy (TBLB) may be a valuable alternative.MethodsRetrospective, monocentric, observational study in mechanically ventilated, critically ill patients, subjected to TBLB due to unexplained pulmonary infiltrates in the period January 2014 to July 2019. Patients` medical records were reviewed to obtain data on baseline clinical characteristics, modality and adverse events (AE) of the TBLB, and impact of the histopathological results on change in therapy. A multivariable binary logistic regression analysis was performed to identify predictors of AE and hospital mortality, and survival curves were generated using the Kaplan-Meier method.ResultsForty-two patients with in total 42 TBLB procedures after a median of 12 days of mechanical ventilation were analyzed, of which 16.7% were immunosuppressed, but there was no patient with prior lung transplantation. Diagnostic yield of the TBLB was 88.1%, with AE occurring in 11.9% (most common pneumothorax and minor bleeding). 92.9% of the procedures were performed as a forceps biopsy, with organizing pneumonia (OP) being the most common histological diagnosis (54.8%). Variables independently associated with hospital mortality were age (odds ratio 1.070, 95%CI 1.006–1.138; p = 0.031) and the presence of OP (0.182, [0.036–0.926]; p = 0.040), the latter being confirmed in the survival analysis (log-rank p = 0.040). In contrast, a change in therapy based on histopathology alone occurred in only 40.5%, and there was no evidence of a survival benefit in those patients.ConclusionsTransbronchial lung biopsy remains a valuable alternative to surgical lung biopsy in mechanically ventilated critically ill patients. However, the high diagnostic yield must be weighed against potential adverse events and limited consequence of the histological result regarding treatment decisions in such patients.

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“…The aetiologies will also vary according to the severity of the haemoptysis. Tuberculosis (TB) has often been identified as one of the most common causes of significant haemoptysis in recent observational studies throughout the world [ 6 ]. However, this finding may not be accurate in some countries with higher socioeconomic levels [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Aetiology, diagnosis and treatment of moderate-to-severe haemoptysis in a North American academic centre

2020

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Significant haemoptysis is a frightening event for patients and clinicians alike. There is a paucity of contemporary literature on the subject.A retrospective analysis of hospitalisations for haemoptysis of more than 50 mL·day−1 in a tertiary referral centre during a 5-year period was performed. Patient's characteristics, haemoptysis aetiology, management and outcome were individually recorded. The aim of this study was to detail the causes of moderate (50–200 mL·day−1) to severe (>200 mL·day−1) haemoptysis along with the diagnostic measures and treatment options used in their management in a 21st century, tertiary-care North American centre.A total of 165 hospitalisations for moderate-to-severe haemoptysis were included in the analysis. Lung cancer (30.3%) and bronchiectasis (27.9%) proved to be most frequent aetiologies. Computed tomography (CT) imaging and bronchoscopy were complementary in identifying the source of bleeding. Bronchial artery embolisation (BAE) was the most common treatment approach (61.8%) and resulted in initial bleeding control in 73.5% of cases. In-hospital mortality was 13.9%, varying from 3.3% in the moderate group to 24.7% in the severe group. Despite being the favoured approach in patients with more severe bleeding, initial BAE therapy was associated with a trend towards lower mortality compared to initial non-BAE therapy.In summary, lung cancer and bronchiectasis were the main causes of moderate-to-severe haemoptysis in our population, CT and bronchoscopy are complementary in identifying the source of bleeding, bleeding volume is associated with outcomes and BAE is a key management tool.

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Approach to Hemoptysis in the Modern Era

Cited by 57 publications

References 111 publications

Managing Massive Hemoptysis

Managing Massive Hemoptysis

Diagnostic Yield, Safety and Impact of Transbronchial Lung Biopsy in Mechanically Ventilated Critically Ill Patients: A Retrospective Study

Aetiology, diagnosis and treatment of moderate-to-severe haemoptysis in a North American academic centre

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