Advertisement

Massive Hemoptysis

  • Jean S. Bussières
Chapter

Abstract

With massive hemoptysis, death is usually caused by asphyxiation rather than by exsanguination. Urgent management focuses on the prevention of asphyxia while the source of bleeding is addressed. Endobronchial and/or angiographic control is usually possible. Bronchial artery embolization is now the treatment of choice. There is now less indication for surgery and surgical results are better in stabilized, “elective,” nonbleeding patient. Pulmonary artery injury is rare but has high mortality.

Keywords

Pulmonary Artery Catheter Bleeding Site Bronchial Artery Rigid Bronchoscope Massive Hemoptysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Jean-Baptiste E. Clinical assessment and management of ­massive hemoptysis. Crit Care Med. 2000;28(5):1642–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Amirana M et al. An aggressive surgical approach to significant hemoptysis in patients with pulmonary tuberculosis. Am Rev Respir Dis. 1968;97(2):187–92.PubMedGoogle Scholar
  3. 3.
    Bobrowitz ID, Ramakrishna S, Shim YS. Comparison of medical v surgical treatment of major hemoptysis. Arch Intern Med. 1983;143(7):1343–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Corey R, Hla KM. Major and massive hemoptysis: ­reassessment of conservative management. Am J Med Sci. 1987;294(5):301–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Garzon AA, Cerruti MM, Golding ME. Exsanguinating ­hemoptysis. J Thorac Cardiovasc Surg. 1982;84(6):829–33.PubMedGoogle Scholar
  6. 6.
    Wigle DA, Waddell TK. Investigation and management of massive hemoptysis. In: Pearson’s thoracic and esophageal surgery. Elsevier: Toronto; 2008. Chapter 38.Google Scholar
  7. 7.
    Remy J et al. Treatment, by embolization, of severe or repeated hemoptysis associated with systemic hypervascularization. Nouv Presse Med. 1973;2(31):2060.PubMedGoogle Scholar
  8. 8.
    Hiebert CA. Balloon catheter control of life-threatening hemoptysis. Chest. 1974;66(3):308–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Fraser KL et al. Transverse myelitis: a reversible complication of bronchial artery embolisation in cystic fibrosis. Thorax. 1997;52(1):99–101.PubMedCrossRefGoogle Scholar
  10. 10.
    Dweik RA, Stoller JK. Role of bronchoscopy in massive hemoptysis. Clin Chest Med. 1999;20(1):89–105.PubMedCrossRefGoogle Scholar
  11. 11.
    Karmy-Jones R, Cuschieri J, Vallieres E. Role of bronchoscopy in massive hemoptysis. Chest Surg Clin N Am. 2001;11(4):873–906.PubMedGoogle Scholar
  12. 12.
    Wedzicha JA, Pearson MC. Management of massive haemoptysis. Respir Med. 1990;84(1):9–12.PubMedCrossRefGoogle Scholar
  13. 13.
    Campos JH. Progress in lung separation. Thorac Surg Clin. 2005;15(1):71–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Spicek-Macan J et al. Exsanguinating tuberculosis-related hemoptysis: bronchial blocker introduced through percutaneous tracheostomy. Minerva Anestesiol. 2009;75(6):405–8.PubMedGoogle Scholar
  15. 15.
    Maguire MF et al. Catastrophic haemoptysis during rigid bronchoscopy: a discussion of treatment options to salvage patients during catastrophic haemoptysis at rigid bronchoscopy. Interact Cardiovasc Thorac Surg. 2004;3(2):222–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Freitag L et al. Three years experience with a new balloon catheter for the management of haemoptysis. Eur Respir J. 1994;7(11):2033–7.PubMedGoogle Scholar
  17. 17.
    Giannoni S et al. Bilateral concurrent massive hemoptysis ­successfully controlled with double endobronchial tamponade. A case report. Minerva Anestesiol. 2006;72(7–8):665–74.PubMedGoogle Scholar
  18. 18.
    Gourin A, Garzon AA. Operative treatment of massive hemoptysis. Ann Thorac Surg. 1974;18(1):52–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Klein U et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology. 1998;88(2):346–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Campos JH, et al. Devices for lung isolation used by anesthesiologists with limited thoracic experience: comparison of double-lumen endotracheal tube, Univent torque control blocker, and Arndt wire-guided endobronchial blocker. Anesthesiology. 2006;104(2):261–6; discussion 5A.Google Scholar
  21. 21.
    Campos JH. Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers. Curr Opin Anaesthesiol. 2007;20(1):27–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Narayanaswamy M et al. Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial ­blockers versus double-lumen tubes. Anesth Analg. 2009;108(4):1097–101.PubMedCrossRefGoogle Scholar
  23. 23.
    de Gregorio MA et al. Hemoptysis workup before embolization: single-center experience with a 15-year period follow-up. Tech Vasc Interv Radiol. 2007;10(4):270–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Ingbar DH. Overview of massive hemoptysis. UpToDate, 2010, December 1st.Google Scholar
  25. 25.
    Poyanli A et al. Endovascular therapy in the management of ­moderate and massive haemoptysis. Br J Radiol. 2007;80(953):331–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Hsiao EI et al. Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis. AJR Am J Roentgenol. 2001;177(4):861–7.PubMedGoogle Scholar
  27. 27.
    Lee EW et al. Bronchial and pulmonary arterial and venous interventions. Semin Respir Crit Care Med. 2008;29(4):395–404.PubMedCrossRefGoogle Scholar
  28. 28.
    Haponik EF, Chin R. Hemoptysis: clinicians’ perspectives. Chest. 1990;97(2):469–75.PubMedCrossRefGoogle Scholar
  29. 29.
    Lippmann ML, Walkenstein MD, Goldberg SK. Bronchoscopy in hemoptysis. Chest. 1990;98(6):1538.PubMedCrossRefGoogle Scholar
  30. 30.
    Tsukamoto T, Sasaki H, Nakamura H. Treatment of hemoptysis patients by thrombin and fibrinogen-thrombin infusion therapy using a fiberoptic bronchoscope. Chest. 1989;96(3):473–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Bense L. Intrabronchial selective coagulative treatment of hemoptysis. Report of three cases. Chest. 1990;97(4):990–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Brandes JC, Schmidt E, Yung R. Occlusive endobronchial stent placement as a novel management approach to massive hemoptysis from lung cancer. J Thorac Oncol. 2008;3(9):1071–2.PubMedCrossRefGoogle Scholar
  33. 33.
    Magee G, Williams Jr MH. Treatment of massive hemoptysis with intravenous pitressin. Lung. 1982;160(3):165–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Mal H et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest. 1999;115(4):996–1001.PubMedCrossRefGoogle Scholar
  35. 35.
    Remy J et al. Treatment of hemoptysis by embolization of bronchial arteries. Radiology. 1977;122(1):33–7.PubMedGoogle Scholar
  36. 36.
    Stoller J. Diagnosis and management of massive hemoptysis: a review. Respir Care. 1992;37:564–81.Google Scholar
  37. 37.
    Bilton D et al. Life threatening haemoptysis in cystic fibrosis: an alternative therapeutic approach. Thorax. 1990;45(12):975–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Chang AB et al. Major hemoptysis in a child with cystic fibrosis from multiple aberrant bronchial arteries treated with tranexamic acid. Pediatr Pulmonol. 1996;22(6):416–20.PubMedCrossRefGoogle Scholar
  39. 39.
    Graff GR. Treatment of recurrent severe hemoptysis in cystic fibrosis with tranexamic acid. Respiration. 2001;68(1):91–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Popper J. The use of premarin IV in hemoptysis. Dis Chest. 1960;37:659–60.PubMedGoogle Scholar
  41. 41.
    Tien HC et al. Successful use of recombinant activated coagulation factor VII in a patient with massive hemoptysis from a penetrating thoracic injury. Ann Thorac Surg. 2007;84(4):1373–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Johnson JL. Manifestations of hemoptysis. How to manage minor, moderate, and massive bleeding. Postgrad Med. 2002;112(4):101–6; 108–9; 113.Google Scholar
  43. 43.
    Zhang JS et al. Bronchial arteriography and transcatheter embolization in the management of hemoptysis. Cardiovasc Intervent Radiol. 1994;17(5):276–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Tanaka N et al. Superselective bronchial artery embolization for hemoptysis with a coaxial microcatheter system. J Vasc Interv Radiol. 1997;8(1 Pt 1):65–70.PubMedCrossRefGoogle Scholar
  45. 45.
    Lee TW et al. Management of massive hemoptysis: a single institution experience. Ann Thorac Cardiovasc Surg. 2000;6(4):232–5.PubMedGoogle Scholar
  46. 46.
    Knott-Craig CJ et al. Management and prognosis of massive hemoptysis. Recent experience with 120 patients. J Thorac Cardiovasc Surg. 1993;105(3):394–7.PubMedGoogle Scholar
  47. 47.
    Endo S et al. Management of massive hemoptysis in a thoracic surgical unit. Eur J Cardiothorac Surg. 2003;23(4):467–72.PubMedCrossRefGoogle Scholar
  48. 48.
    Bussieres JS. Iatrogenic pulmonary artery rupture. Curr Opin Anaesthesiol. 2007;20(1):48–52.PubMedCrossRefGoogle Scholar
  49. 49.
    Kearney TJ, Shabot MM. Pulmonary artery rupture associated with the Swan-Ganz catheter. Chest. 1995;108(5):1349–52.PubMedCrossRefGoogle Scholar
  50. 50.
    Poplausky MR et al. Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm formation: three case reports and a review of the literature. Chest. 2001;120(6):2105–11.PubMedCrossRefGoogle Scholar
  51. 51.
    Stratmann G, Benumof JL. Endobronchial hemorrhage due to pulmonary circulation tear: separating the lungs and the air from the blood. Anesth Analg. 2004;99(5):1276–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Dopfmer UR, et al. Treatment of severe pulmonary hemorrhage after cardiopulmonary bypass by selective, temporary balloon occlusion. Anesth Analg. 2004;99(5):1280–2; table of contents.Google Scholar
  53. 53.
    Bianchini R et al. Extracorporeal membrane oxygenation for Swan-Ganz induced intraoperative hemorrhage. Ann Thorac Surg. 2007;83(6):2213–4.PubMedCrossRefGoogle Scholar
  54. 54.
    Gottwalles Y, Wunschel-Joseph ME, Hanssen M. Coil embolization treatment in pulmonary artery branch rupture during Swan-Ganz catheterization. Cardiovasc Intervent Radiol. 2000;23(6):477–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Fortin M et al. Catheter-induced pulmonary artery rupture: using occlusion balloon to avoid lung isolation. J Cardiothorac Vasc Anesth. 2006;20(3):376–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Mullerworth MH et al. Recognition and management of ­catheter-induced pulmonary artery rupture. Ann Thorac Surg. 1998;66(4):1242–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Utsumi T et al. Swan-Ganz catheter-induced pseudoaneurysm of the pulmonary artery. Jpn J Thorac Cardiovasc Surg. 2002;50(8):347–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Ingbar D. Life threatening hemoptysis. In: Shoemaker W, editor. Textbook of critical care. 4th ed. Philadelphia: WB Saunders; 1515.Google Scholar
  59. 59.
    Chauhan S et al. Case 6 – 2001: exsanguinating endotracheal hemorrhage during cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2001;15(3):377–80.PubMedCrossRefGoogle Scholar
  60. 60.
    Grant CA, Dempsey G, Harrison J, Jones T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth. 2006;96:127–30.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of AnesthesiologyInstitut Universitaire de Cardiologie et de Pneumologie de QuebecVille de QuebecCanada

Personalised recommendations