Massive hemoptysis requiring intensive care.
OBJECTIVE
Massive hemoptysis can cause airway or hemodynamic compromise requiring intensive care. We reviewed the management and outcome of this group of patients in our institution.


METHODS
Retrospective analysis.


METHODS
Medical intensive care unit (MICU) in a tertiary care hospital.


METHODS
Patients (29 patients with 31 episodes) who were admitted to the MICU for massive hemoptysis (greater than 300 ml/24 h or requiring intubation) between August 1997 and April 2001.


RESULTS
Patients were intensively monitored and electively intubated if there was danger of airway compromise. Fiberoptic bronchoscopy was performed to assess the site of bleeding and patients had bronchial artery embolisation if deemed suitable. Patients in whom bleeding could not be controlled were referred for emergency surgery.


RESULTS
In 26/31 (84%) episodes, patients required intubation. Bronchoscopy was more helpful in localising the bleeding (site of bleeding identified in 90%) than chest X-ray alone (identified site of bleeding in 64%). Bleeding was stopped with medical therapy in 8/31 (26%) patient; 16/31(51%) patients were successfully treated with embolisation. Only four (13%) patients went for emergency surgery, of whom one died. Overall in-hospital mortality was 4/31 patients (13%). Over a 2 year follow-up, 6/27 (22%) survivors had recurrent hemoptysis and another 4 (15%) died of unrelated causes.


CONCLUSIONS
Intensive care and monitoring with endotracheal intubation, when necessary, are useful in massive hemoptysis. Bronchoscopy should be performed to help localise the bleeding site. Embolisation is a suitable first-line treatment for massive hemoptysis, reserving emergency surgery for cases where the above measures are insufficient to control bleeding.
Ong
Thun-How
TH
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore169608, Singapore. gm3oth@sgh.com.sg
Eng
Philip
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001987:Bronchiectasis / Q000150:complications; D001999:Bronchoscopy; D003422:Critical Care / Q000379:methods*; D003663:Decision Trees; D004621:Embolization, Therapeutic; D004630:Emergencies; D005260:Female; D006469:Hemoptysis / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000150:complications; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications