Severe respiratory failure due to diffuse alveolar hemorrhage: clinical characteristics and outcome of intensive care.
BACKGROUND
The aim of this study was to characterize patients and report outcome of diffuse alveolar hemorrhage (DAH) requiring intensive care unit support.


METHODS
Thirty-seven patients were identified. Clinical characteristics and outcome were determined by chart review.


RESULTS
Eighty-nine percent of patients presented with shortness of breath, 23% with cough, and 3% with hemoptysis. In 9% of patients, a diagnosis of DAH was suspected on admission. Diagnosis was confirmed by finding a progressively hemorrhagic bronchoalveolar lavage fluid in 89% and by a positive iron stain in 11% of patients. Vasculitis was causative in 19%, drug toxicity in 11%, thrombocytopenia in 27%, stem-cell transplantation in 5%, sepsis-associated lung injury in 22%, and unknown mechanisms in 16%. Thirty-two patients were mechanically ventilated, 4 received noninvasive ventilation, and 1 received supplemental oxygen therapy. Overall, 18 (49%) of 37 patients survived the intensive care unit stay. Survival was markedly different between patients with an immunologic/unknown etiology (82%) and patients with thrombocytopenia and/or sepsis (22%).


CONCLUSIONS
Diffuse alveolar hemorrhage should be considered in all patients with persistent pulmonary infiltrates. Both bronchoalveolar lavage fluid and iron stain are mandatory diagnostic means. Patients with an immunologic/idiopathic pathogenetic mechanism have a relatively good prognosis, whereas the outcome in individuals with DAH secondary to cancer therapy or sepsis is poor.
Rabe
Christian
C
Medical ICU, Department of Internal Medicine I, University of Bonn, D-53105 Bonn, Germany. rabe@uni-bonn.de
Appenrodt
Beate
B
Hoff
Christian
C
Ewig
Santiago
S
Klehr
Hans Ulrich
HU
Sauerbruch
Tilman
T
Nickenig
Georg
G
Tasci
Selçuk
S
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D003937:Diagnosis, Differential; D005260:Female; D006470:Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011650:Pulmonary Alveoli / Q000473:pathology*; D012131:Respiratory Insufficiency / Q000209:etiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome