Massive hemoptysis: what place for medical and surgical treatment.
OBJECTIVE
The objective of the study was to define timing of surgical treatment in management of massive hemoptysis.


METHODS
We performed a retrospective review of all patients admitted for massive hemoptysis in the intensive care unit of our thoracic surgery department. Treatment was managed according to the patient's status, the etiology of bleeding, the findings of bronchoscopy and computed tomographic scan. Therapeutic measures available were medical treatment, tracheal intubation (single or double lumen tube), interventional endoscopy, arterial embolisation and surgical treatment.


RESULTS
Between September 1996 and December 2001, 43 patients were treated (nine females and 34 males with mean age of 54 years, range from 32 to 79). The mean red cell blood transfusion per patient was 1.57 Units. The patients were classified into three groups: Group 1, 11 patients were operated on immediately close to the bleeding crise (five pneumonectomy and six lobectomy); Group 2, five patients for whom operation was delayed from the 7th to the 22nd day after cessation of bleeding (five lobectomy); Group 3, 27 patients were treated by non-surgical methods (medical treatment, endobronchial treatment, percutaneous embolisation). Fifteen patients underwent an arterial embolization, which was complete in 13 cases. Among the five patients of group 2, cessation of bleeding was obtained by bronchial embolisation in four cases. Considering the whole series, 10 (23%) patients died: three (19%) patients in group 1, zero in group 2, seven (26%) in group 3. In two patients who were suffering from tumor necrosis, hemoptysis relapsed leading to death.


CONCLUSIONS
Emergency thoracotomy for massive hemoptysis is at high risk. In case of bleeding from the arterial bronchial vessels, embolization may enable to postpone surgery and operate secondarily. In case of bleeding from the pulmonary vessels (tumor necrosis), surgical treatment must be immediate. An algorithm for management is proposed.
Jougon
Jacques
J
Department of Thoracic Surgery, Haut-Lévêque Hospital, Bordeaux University Hospital, avenue de Magellan, 33604 Pessac, France. jacques.jougon@chu-bordeaux.fr
Ballester
Michel
M
Delcambre
Frédéric
F
Mac Bride
Tarun
T
Valat
Philippe
P
Gomez
Francis
F
Laurent
François
F
Velly
Jean François
JF
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001980:Bronchi / Q000098:blood supply; D004621:Embolization, Therapeutic; D005260:Female; D006469:Hemoptysis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed