[The use of fibrinogen-thrombin via endoscope in the treatment of massive hemoptysis].
We assessed the efficacy of fibrinogen-thrombin instillation through the fiberoptic bronchoscope to treat massive hemoptysis in patients to whom embolization of bronchial arteries was not available, was contraindicated or had failed. The fibrinogen-thrombin solution used was Tissucol, which in addition to 2% fibrinogen and 4 U/ml of thrombin, also contained factor XIII an aprotinin. The fibrinogen-thrombin solution was instilled with the aid of the Duplojec system and a 70 cm x 2 mm 4-way catheter. In 53 of the 628 fiberoptic bronchoscopies performed during the study, the indication was hemoptysis > or = 150 ml/12 h. Of these, bronchoscopic instillation of fibrinogen-thrombin was indicated in 5 cases because bronchial artery embolization was impossible. The point of bleeding was located by bronchoscopy in all cases and fibrinogen-thrombin instillation controlled hemoptysis immediately and throughout the follow-up period, which ranged 4 to 10 months. Morning expectoration of blood (< 10 ml) was observed in only 1 patient in the 3 days after treatment. The mean time taken for bronchoscopic exploration was 3 minutes (range, 2-7). In all cases fiberoptic bronchoscopy was performed without complications that might have required the procedure to be suspended. We conclude that the local use of fibrinogen-thrombin or fibrin glue instilled through the fiberoptic bronchoscope to the point of bleeding is a simple, fast and cheap way to control massive hemoptysis on a short and long-term basis.(ABSTRACT TRUNCATED AT 250 WORDS)
de Gracia
J
J
Servicio de Neumologia, Hospital General Universitario Vall d'Hebron, Barcelona.
Mayordomo
C
C
Catalán
E
E
Vendrell
M
M
Martí
S
S
Bravo
C
C
D000328:Adult; D000368:Aged; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods*; D004341:Drug Evaluation; D004630:Emergencies; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000188:drug therapy*; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged
D015718:Fibrin Tissue Adhesive
Utilización de fibrinógeno-trombina por vía endoscópica en el tratamiento de la hemoptisis masiva.