Life-Threatening Hemoptysis in a Pediatric Referral Center

Abstract

OBJECTIVES: Hemoptysis is uncommon in children, even among the critically ill, with a paucity of epidemiological data to inform clinical decision-making. We describe hemoptysis-associated ICU admissions, including those who were critically ill at hemoptysis onset or who became critically ill as a result of hemoptysis, and identify predictors of mortality. DESIGN: Retrospective cohort study. Demographics, hemoptysis location, and management were collected. Pediatric Logistic Organ Dysfunction-2 score within 24 hours of hemoptysis described illness severity. Primary outcome was inhospital mortality. SETTING: Quaternary pediatric referral center between July 1, 2010, and June 30, 2017. PATIENTS: Medical/surgical (PICU), cardiac ICU, and term neonatal ICU admissions with hemoptysis during or within 24 hours of ICU admission. INTERVENTIONS: No intervention. MEASUREMENTS AND MAIN RESULTS: There were 326 hemoptysis-associated ICU admissions in 300 patients. Most common diagnoses were cardiac (46%), infection (15%), bronchiectasis (10%), and neoplasm (7%). Demographics, interventions, and outcomes differed by diagnostic category. Overall, 79 patients (26%) died inhospital and 109 (36%) had died during follow-up (survivor mean 2.8 ± 1.9 yr). Neoplasm, bronchiectasis, renal dysfunction, inhospital hemoptysis onset, and higher Pediatric Logistic Organ Dysfunction-2 score were independent risk factors for inhospital mortality (p < 0.02). Pharmacotherapy (32%), blood products (29%), computerized tomography angiography (26%), bronchoscopy (44%), and cardiac catheterization (36%) were common. Targeted surgical interventions were rare. Of survivors, 15% were discharged with new respiratory support. Of the deaths, 93 (85%) occurred within 12 months of admission. For patients surviving 12 months, 5-year survival was 87% (95% CI, 78–92) and mortality risk remained only for those with neoplasm (log-rank p = 0.001). CONCLUSIONS: We observed high inhospital mortality from hemoptysis-associated ICU admissions. Mortality was independently associated with hemoptysis onset location, underlying diagnosis, and severity of critical illness at event. Additional mortality was observed in the 12-month posthospital discharge. Future directions include further characterization of this vulnerable population and management recommendations for life-threatening pediatric hemoptysis incorporating underlying disease pathophysiology.

Bronchial Artery to Pulmonary Artery Fistula Presenting with Massive Hemoptysis in a Pediatric Patient

“…Bronchial artery embolization (BAE) was first described by Remy and colleagues in 1974. It has been widely used as treatment for hemoptysis in peditartic patients, including those with CF, and has been shown to be safe and effective (Moynihan et al, 2021).…”

“…Clinicians should not overlook congenital vascular anomalies as a cause due to their risk of catastrophic haemorrhage. BAE is a relatively safe method to treat hemoptysis and has been also demonstrated to be effective in pediatric patients, including those with CF (Moynihan et al, 2021). Clinicians should be cognizant of the multidisciplinary care required to treat pediatric patients with hemoptysis and ensure that services are readily available to guarantee optimal outcomes.…”

Bronchial artery to pulmonary artery fistula presenting with massive hemoptysis in a pediatric patient

“…Bronchial artery embolization (BAE) was first described by Remy et al in 1974. It has been widely used as a treatment for hemoptysis in pediatric patients, including those with cystic fibrosis (CF), and has been shown to be safe and effective 5 …”

“…Clinicians should not overlook congenital vascular anomalies as a cause due to their risk of catastrophic hemorrhage. BAE is a relatively safe method to treat hemoptysis and has been also demonstrated to be effective in pediatric patients, including those with CF 5 . Clinicians should be cognizant of the multidisciplinary care required to treat pediatric patients with hemoptysis and ensure that services are readily available to guarantee optimal outcomes.…”

“…It has been widely used as a treatment for hemoptysis in pediatric patients, including those with cystic fibrosis (CF), and has been shown to be safe and effective. 5 Hemoptysis is a serious and potentially fatal event that is thankfully rare in pediatric patients. A high clinical suspicion should be maintained when assessing a pediatric patient presenting with hemoptysis.…”