Endobronchial Urokinase for Dissolution of Massive Clot Following Transbronchial Biopsy

Botnick, Warren C.; Brown, Harvey V.

doi:10.1378/chest.105.3.953

Cited by 18 publications

(14 citation statements)

References 8 publications

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“…Acute airway obstruction due to the presence of blood clots occurs in a variety of clinical conditions, including complications of respiratory disease, such as tuberculosis, bronchiectasis, bronchial carcinoma, and pulmonary arteriovenous malformations, as well as other causes, such as anticoagulation or pancytopenia1,2,3,4,5,6. These conditions may result in lifethreatening impairment of ventilation.…”

Section: Discussionmentioning

confidence: 99%

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Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

et al. 2014

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Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

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Section: Discussionmentioning

confidence: 99%

“…An endobronchial blood clot is an unsusal, albeit not rare cause of airway obstruction1,2,3. In spontaneously breathing patients, the clinical features of endobronchial blood clots may resolve rapidly when blood clots are coughed up.…”

Section: Introductionmentioning

confidence: 99%

Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

et al. 2014

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“…Thus, we decided to searched the PubMed database using the terms "massive hemoptysis and thrombolytic". The search resulted in 26 articles, including 3 rare cases ( 4 - 6 ) successfully treated with thrombolytic therapy by infusion using a bronchoscope. The procedure was thus performed in a similar manner as described.…”

Section: Discussionmentioning

confidence: 99%

Massive hemoptysis successfully treated with extracorporeal membrane oxygenation and endobronchial thrombolysis

Júnior¹,

Chaves

Santos

et al. 2018

Revista Brasileira De Terapia Intensiva

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Extracorporeal membrane oxygenation has been used to treat refractory hypoxemia in numerous clinical scenarios. The fundamental principles for the management of massive hemoptysis patients include protecting the airway and healthy lung, locating the source of bleeding and controlling the hemorrhage. We report the case of a patient with acute respiratory failure associated with massive hemoptysis secondary to lung laceration during cardiac surgery. The use of extracorporeal membrane oxygenation allowed patient survival. However, due to the great difficulty in managing pulmonary clots after hemoptysis, it was necessary to use an unusual therapy involving endobronchial infusion of a thrombolytic agent as described in rare cases in the literature.

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“…Koagel sind mit Zangen schwer zu fassen, eine praktikable Alternative ist das Vereisen und Herausziehen mit der Kryosonde. Zum Auflösen peripher deponierter Koagel ist auch die lokale Gabe von Fibrinolytika wie Urokinase empfohlen worden [30].…”

Section: Tamponadeunclassified

H�moptysen

2004

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Hemoptysis is a potentially life-threatening complication of various diseases. The most common causes are infectious and inflammatory processes, followed by neoplasms, pulmonary embolisms, mitral stenoses, coagulopathies, and multiple systemic disorders. Primary examinations include a chest x-ray, an angio CT and a bronchoscopy. Sometimes, a bronchial artery angiogram is required. The patient is at risk of suffocation because blood and clots can severely obstruct his airways. Thus, the most important measures are: supplemental oxygen, positioning the patient with the bleeding side down, bronchoscopical suctioning and removal of blood and clots. Coagulopathies have to be corrected. Application of vasoactive drugs may help temporarily. In cases of bleeding from central lesions, coagulation with laser or argon-plasma-coagulator is feasible. Heavy bleeding from the periphery requires a balloon or tube tamponade. Depending on the cause and the severity of the bleeding either anti-inflammatory medical treatment, hemostyptic radiation therapy, bronchial artery embolisation or a surgical procedure must follow.

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Endobronchial Urokinase for Dissolution of Massive Clot Following Transbronchial Biopsy

Cited by 18 publications

References 8 publications

Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

Massive hemoptysis successfully treated with extracorporeal membrane oxygenation and endobronchial thrombolysis

H�moptysen

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