Exsanguinating tuberculosis-related hemoptysis: bronchial blocker introduced through percutaneous tracheostomy.
Life-threatening hemoptysis is very rare and, fortunately, not many physicians have experienced it. The unpredictability of massive hemoptysis is often underestimated in seemingly stable patients and becomes fatal within a few minutes. The current definitions of massive and/or life-threatening hemoptysis in the medical literature are inadequate and the specific recommendations for the management of such conditions, based on sporadic case reports, are inadequate as well. We report herein a case of active tuberculosis-related exsanguinating hemoptysis (>1500 mL of blood within minutes) in a 26-year-old male, which illustrates the essential issues in the management of this condition; the pertinent literature is also reviewed. After a cardiac arrest with successful resuscitation, in an effort to reduce the risk of recurrent hemoptysis, we introduced a bronchial blocker (i.e., a Fogarty catheter), as guided by a fiberoptic bronchoscope, into the right main bronchus through several days earlier performed percutaneous tracheostomy because of patient's respiratory insufficiency. Several factors played a crucial role in the patient's survival. The main purpose of this case report is to contribute to the management of hemoptysis that leads to exsanguination within minutes and the originality of this report entails the introduction of bronchial blocker through the percutaneous tracheal cannula.
Spicek-Macan
J
J
Department of Anesthesiology and Intensive Care, Jordanovac University Hospital for Chest Diseases, Zagreb, Croatia. darko.macan1@zg.htnet.hr
Hodoba
N
N
Nikolic
I
I
Stancic-Rokotov
D
D
Kolaric
N
N
Popovic-Grle
S
S
D000328:Adult; D001980:Bronchi; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods*; D016887:Cardiopulmonary Resuscitation; D006469:Hemoptysis / Q000209:etiology*; D006801:Humans; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D014397:Tuberculosis, Pulmonary / Q000150:complications*