title: Endobronchial Valve Used as Salvage Therapy in a Mechanically Ventilated Patient with Intractable Life-Threatening Haemoptysis.
abstract: Treatment options for intractable life-threatening haemoptysis in mechanically ventilated patients with structural lung disease who do not respond to bronchial artery embolisation (BAE) and who are deemed unfit for surgery are limited. A 26-year-old HIV-positive male with a poorly preserved CD4 count and active pulmonary tuberculosis was intubated and mechanically ventilated for persistent life-threatening haemoptysis. Two attempts at BAE failed, and life-threatening haemoptysis recurred daily for 14 days despite antituberculous therapy. He was deemed unfit for surgery during that period. We proceeded to identify the source of bleeding endoscopically and implanted an endobronchial valve in the left upper lobe bronchus. Following the collapse of the affected lobe, haemoptysis ceased and the patient was promptly liberated from mechanical ventilation. He remained haemoptysis free for the duration of his hospitalisation. Endobronchial valves, therefore, may be a viable option in patients mechanically ventilated with persistent life-threatening haemoptysis in whom all other conventional measures fail and who are considered unfit for surgery.
authors.affiliation: Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
authors.forename: Usha
authors.initials: U
authors.lastname: Lalla
authors.forename: Brian W
authors.initials: BW
authors.lastname: Allwood
authors.forename: Soumitra
authors.initials: S
authors.lastname: Sinha Roy
authors.forename: Elvis M
authors.initials: EM
authors.lastname: Irusen
authors.forename: Coenraad F N
authors.initials: CFN
authors.lastname: Koegelenberg
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D015658:HIV Infections / Q000150:complications; D006469:Hemoptysis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D019736:Prostheses and Implants; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D016879:Salvage Therapy; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000601:surgery*; D013396:Suction; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy
chemical_list: D000995:Antitubercular Agents
keywords: Endobronchial valve; Haemoptysis