Management of massive haemoptysis with the rigid bronchoscope and cold saline lavage.

Abstract

Twelve successive patients with massive haemoptysis were treated by emergency rigid bronchoscopy and lavage of the bleeding lung with cold saline. All patients stopped bleeding during the procedure and all blood and clot was evacuated from the accessible airways. The bleeding source was localised to a lobe in seven cases, and lateralised in the remaining five patients. Two patients had a second haemorrhage during that hospital stay and cold saline lavage again terminated it. Further therapy, either surgical or medical was based on information obtained during the respite from haemorrhage achieved with this technique. There was no hospital mortality in the series.The conservative management of haemoptysis is generally successful, but 10-15% of all patients with rhaemoptysis may bleed to a life-threatening extent.1 2 This figure includes patients with limited pulmonary reserve in whom the spillage of moderate amounts of blood into the tracheobronchial tree causes critical deterioration in lung function, and those in danger of asphyxiation from the sheer volume of blood aspirated. The various methods of management of lifethreatening haemoptysis include drug therapy endoscopic control measures (endobronchial balloon tamponade, topical adrenalin application, and lung isolation with double lumen endotracheal tubes), bronchial artery embolisation techniques, and lung resection. The performance of a pulmonary resection on a patient who is actively bleeding and whose respiratory reserve is unknown is necessarily hazardous. The occurrence of massive haemoptysis in poor risk patients has encouraged the development of nonsurgical methods of management. Our experience with emergency rigid bronchoscopy and cold saline lavage in 12 patients with massive haemoptysis forms the basis of this report. No similar experience has been reported.

Hemoptysis: A 10-Year Retrospective Study

“…Treatment of hemoptysis includes taking medical conservative noninvasive measures at presentation. [11][12][13][14] If these measures are not effective, then more aggressive measures are utilized, including radiological invasive maneuvers and surgical approaches. [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.…”

“…[11][12][13][14] If these measures are not effective, then more aggressive measures are utilized, including radiological invasive maneuvers and surgical approaches. [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%.…”

Controle da hemoptise maciça com broncoscopia rígida e soro fisiológico gelado

“…Em países desenvolvidos as bronquiectasias ocupam o primeiro lugar. (4,(15)(16)(17)(18)(19)(20) Conlan e Hurwitz (14) publicaram em 1980 os resultados obtidos em 12 pacientes que tiveram hemoptise maciça, 600ml ou mais em 24h, controlada com broncoscopia rígida sob anestesia geral e lavagem endobrônquica com soro fisiológico gelado a 4 o C. Posteriormente, Conlan et al, (15) em 1983, agora em 23 doentes, confirmaram os resultados. O volume utilizado de soro fisiológico gelado variou de 300ml a 750ml, com média de 500ml.…”

“…(2,14,15) Obtivemos o controle imediato da hemoptise em nossos 94 pacientes. O volume de soro fisiológico gelado utilizado variou de 160ml a 2.500ml, com média de 582ml.…”

“…(1,2,4,5,8,(9)(10)(11)(12)(13) Vários são os métodos utilizados para o controle da hemoptise que ameaça a vida, tais como: embolização das artérias brônquicas, lavagem endobrônquica com soro fisiológico gelado, pneumoperitônio, pneumotórax, bloqueios brônquicos, intubação brônquica seletiva, uso do laser, da vasopressina e outros. Conlan e Hurwitz, (14) em 1980, mostraram a possibilidade de controlar a hemoptise maciça com broncoscopia rígida e lavagem endobrôn-quica regrada com soro fisiológico gelado a 4 o C.…”