Managing life-threatening hemoptysis: has anything really changed?
OBJECTIVE
To delineate current chest clinicians' approaches to the management of patients with life-threatening hemoptysis.


METHODS
Survey during a computer-assisted interactive continuing medical education presentation.


METHODS
The 1998 American College of Chest Physicians (ACCP) Annual Scientific Assembly.


METHODS
Chest clinicians attending the respiratory emergency symposium.


RESULTS
Most clinicians (86%) had cared for patients with life-threatening hemoptysis, and 28% had cared for patients with fatal events during the previous year. Those clinicians favored management in the ICU setting (95%) with early endotracheal intubation (85%), and they tended to use a large-bore, single-lumen endotracheal tube (57%). The majority (64%) favored the early performance of diagnostic bronchoscopy during the first 24 h. Most clinicians (79%) used the flexible instrument, a higher frequency than respondents at a similar symposium on hemoptysis at the 1988 ACCP meeting (48%; p < 0.0001). Most current clinicians (77%) had experience with endobronchial measures to control bleeding, but few (14%) found them to be consistently worthwhile. Chest CT scanning was often helpful in diagnosis (55%). In their management of bleeding, half of these clinicians favored the use of interventional angiography, even in operable patients, which is a substantial change from 1988 when 23% had favored this approach (p < 0.0001).


CONCLUSIONS
During the past decade, life-threatening hemoptysis has remained an important problem. Flexible bronchoscopy and interventional angiography have become increasingly established, more widely accepted approaches to patient care.
Haponik
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EF
Department of Internal Medicine, Section on Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Fein
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Chin
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D000792:Angiography; D001291:Attitude of Health Personnel; D020680:Bronchoscopes; D001999:Bronchoscopy; D003422:Critical Care; D004630:Emergencies; D004867:Equipment Design; D006469:Hemoptysis / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D015272:Pulmonary Medicine; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed