Bronchoscopy-guided topical hemostatic tamponade therapy for the management of life-threatening hemoptysis.
OBJECTIVE
Massive hemoptysis is a life-threatening condition. Therapeutic strategies such as interventional angiography, surgery, and/or bronchoscopy have been applied in the clinical setting with variable results. We investigated the efficacy of bronchoscopy-guided topical hemostatic tamponade therapy (THT) using oxidized regenerated cellulose (ORC) mesh in the management of life-threatening hemoptysis.


METHODS
Seventy-six consecutive patients underwent emergency bronchoscopy for massive hemoptysis. Fifty-seven patients (75%) had persistent endobronchial bleeding despite bronchoscopic wedging technique, cold saline solution lavage, and instillation of regional vasoconstrictors. These patients subsequently underwent THT according to the same procedure.


METHODS
Teaching hospital, bronchoscopy unit of a 300-bed tertiary pulmonary referral center.


RESULTS
THT with ORC was successfully performed on 56 of 57 patients (98%) with an immediate arrest of hemoptysis. All patients successfully treated with THT remained free of hemoptysis for the first 48 h. None required intensive care support or immediate surgery. Mean procedure time (+/- SD) of THT was 11.5 +/- 4.2 min. Recurrence of hemoptysis that was characterized as being mild (< 30 mL) to moderate (30 to 100 mL) developed in six patients (10.5%) 3 to 6 days after THT. Post-obstructive pneumonia developed in five subjects (9%) after endoscopic THT. A subgroup of patients (n = 14) underwent bronchoscopic follow-up 4 weeks after discharge. The ORC mesh was absorbed in all of these patients without signs of foreign body reaction.


CONCLUSIONS
Endobronchial THT using ORC is a safe and practicable technique in the management of life-threatening hemoptysis with a high success and a relatively low complication rate.
Valipour
Arschang
A
Department of Respiratory and Critical Care Medicine and Ludwig-Boltzmann Institute for COPD, Otto-Wagner-Spital, Sanatoriumsstr. 2, 1140 Wien, Vienna, Austria. arschang.valipour@wienkav.at
Kreuzer
Alois
A
Koller
Hubert
H
Koessler
Wolfgang
W
Burghuber
Otto Chris
OC
D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D002482:Cellulose / Q000494:pharmacology*; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013526:Surgical Mesh; D015996:Survival Rate; D016896:Treatment Outcome
D002482:Cellulose