An integrated approach to diagnosis and management of severe haemoptysis in patients admitted to the intensive care unit: a case series from a referral centre.
BACKGROUND
Limited data are available concerning patients admitted to the intensive care unit (ICU) for severe haemoptysis. We reviewed a large series of patients managed in a uniform way to describe the clinical spectrum and outcome of haemoptysis in this setting, and better define the indications for bronchial artery embolisation (BAE).


METHODS
A retrospective chart review of 196 patients referred for severe haemoptysis to a respiratory intermediate care ward and ICU between January 1999 and December 2001. A follow-up by telephone interview or a visit.


RESULTS
Patients (148 males) were aged 51 (+/- sd, 16) years, with a median cumulated amount of bleeding averaging 200 ml on admission. Bronchiectasis, lung cancer, tuberculosis and mycetoma were the main underlying causes. In 21 patients (11%), no cause was identified. A first-line bronchial arteriography was attempted in 147 patients (75%), whereas 46 (23%) received conservative treatment. Patients who underwent BAE had a higher respiratory rate, greater amount of bleeding, persistent bloody sputum and/or evidence of active bleeding on fiberoptic bronchoscopy. When completed (n = 131/147), BAE controlled haemoptysis in 80% of patients, both in the short and long (> 30 days) terms. Surgery was mostly performed when bronchial arteriography had failed and/or bleeding recurred early after completed BAE. Bleeding was controlled by conservative measures alone in 44 patients. The ICU mortality rate was low (4%).


CONCLUSIONS
Patients with evidence of more severe or persistent haemoptysis were more likely to receive BAE rather than conservative management. The procedure was effective and safe in most patients with severe haemoptysis, and surgery was mostly reserved to failure of arteriography and/or early recurrences after BAE.
Fartoukh
Muriel
M
Service de Pneumologie et Unité de Réanimation Respiratoire, Hôpital Tenon, Assistance Publique--Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France. muriel.fartoukh@tnn.aphp.fr
Khalil
Antoine
A
Louis
Laurence
L
Carette
Marie-France
MF
Bazelly
Bernard
B
Cadranel
Jacques
J
Mayaud
Charles
C
Parrot
Antoine
A
D000792:Angiography; D001981:Bronchial Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D003422:Critical Care / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods; D005500:Follow-Up Studies; D005602:France; D006469:Hemoptysis / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome