title: Severe respiratory failure due to diffuse alveolar hemorrhage: clinical characteristics and outcome of intensive care.
abstract: 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.
authors: Medical ICU, Department of Internal Medicine I, University of Bonn, D-53105 Bonn, Germany. rabe@uni-bonn.de
authors: Christian
authors: C
authors: Rabe
authors: Beate
authors: B
authors: Appenrodt
authors: Christian
authors: C
authors: Hoff
authors: Santiago
authors: S
authors: Ewig
authors: Hans Ulrich
authors: HU
authors: Klehr
authors: Tilman
authors: T
authors: Sauerbruch
authors: Georg
authors: G
authors: Nickenig
authors: Selçuk
authors: S
authors: Tasci
mesh_terms: 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