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Toh TW, Goh JHF, Lie SA, Leong CKL, Hwang NC. Clinical Approach to Massive Hemoptysis: Perioperative Focus on Causes and Management. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00374-4. [PMID: 38964992 DOI: 10.1053/j.jvca.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/30/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024]
Abstract
Massive hemoptysis is a time critical airway emergency in the perioperative setting, with an associated mortality exceeding 50%. Causes of hemoptysis in the perioperative setting include procedural complication, coagulopathy, malignancy, chronic lung disease, infection, left-sided cardiac disease, pulmonary vascular disease and autoimmune disease. A rapid and coordinated multidisciplinary response is required to secure the airway, isolate the lung, ensure adequate oxygenation and ventilation, identify the underlying cause and initiate specific systemic, bronchoscopic, endovascular, or surgical treatment. This review examines the etiology, pathophysiology, as well as approach to management and interventions in perioperative massive hemoptysis.
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Affiliation(s)
- Timothy Weiquan Toh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Jacqueline Hui Fen Goh
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
| | - Sui An Lie
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Carrie Kah Lai Leong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
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Parrot A, Canellas A, Barral M, Gibelin A, Cadranel J. [Severe hemoptysis in the onco-hematology patient]. Rev Mal Respir 2024; 41:303-316. [PMID: 38155073 DOI: 10.1016/j.rmr.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment, in-hospital mortality exceeds 60%, even reaching 100% at 6 months. The management of severe hemoptysis should be discussed with the oncologist. Aside from situations of threatening hemoptysis, in which bronchoscopy should be performed immediately, CT angiography is an essential means of localizing the bleeding and determining the causes and the vascular mechanisms involved. In more than 90% of cases, hemoptysis is linked to systemic bronchial or non-bronchial hypervascularization, whereas in fewer than 5%, it is associated with pulmonary arterial origin or, exceptionally, with damage to the alveolar-capillary barrier. The most severely ill patients must be treated in intensive care in centers equipped with interventional radiology, thoracic surgery and, ideally, with interventional bronchoscopy. Interventional radiology is the first-line symptomatic treatment. In over 80% of cases, bronchial arteriography with embolization allows immediate control. Emergency surgery should be avoided, as it is associated with significant mortality. Appropriate and adequate care reduces hospital mortality to 30%, enabling patients to benefit from the most recent, survival-prolonging treatments.
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Affiliation(s)
- A Parrot
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France.
| | - A Canellas
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - M Barral
- Service de radiologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
| | - A Gibelin
- Service de médecine intensive et réanimation, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - J Cadranel
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
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Singer ED, Faiz SA, Qdaisat A, Abdeldaem K, Dagher J, Chaftari P, Yeung SCJ. Hemoptysis in Cancer Patients. Cancers (Basel) 2023; 15:4765. [PMID: 37835458 PMCID: PMC10571539 DOI: 10.3390/cancers15194765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Hemoptysis in cancer patients can occur for various reasons, including infections, tumors, blood vessel abnormalities and inflammatory conditions. The degree of hemoptysis is commonly classified according to the quantity of blood expelled. However, volume-based definitions may not accurately reflect the clinical impact of bleeding. This review explores a more comprehensive approach to evaluating hemoptysis by considering its risk factors, epidemiology and clinical consequences. In particular, this review provides insight into the risk factors, identifies mortality rates associated with hemoptysis in cancer patients and highlights the need for developing a mortality prediction score specific for cancer patients. The use of hemoptysis-related variables may help stratify patients into risk categories; optimize the control of bleeding with critical care; implement the use of tracheobronchial or vascular interventions; and aid in treatment planning. Effective management of hemoptysis in cancer patients must address the underlying cause while also providing supportive care to improve patients' quality of life.
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Affiliation(s)
- Emad D. Singer
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saadia A. Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aiham Qdaisat
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
| | - Karim Abdeldaem
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
| | - Jim Dagher
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 1100, Lebanon
| | - Patrick Chaftari
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
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Benjamin SR, Nair AA, Joel RK, Gnanamuthu BR, Rao VM, Andugala SS. An overview on the principles of management of haemoptysis. Indian J Thorac Cardiovasc Surg 2023; 39:505-515. [PMID: 37609603 PMCID: PMC10442015 DOI: 10.1007/s12055-023-01547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 05/24/2023] [Indexed: 08/24/2023] Open
Abstract
Haemoptysis is a frequently encountered presentation in thoracic surgery practice. Most of the patients present with chronic haemoptysis while 5% of them will present with life-threatening acute haemoptysis. Emergency surgery used to be the first-line management in acute life-threatening haemoptysis which resulted in significant morbidity and mortality. With advancements in interventional procedures, most of these acute presentations are now being managed conservatively by interventionists. In a country like India with a high incidence of tuberculosis and other infectious diseases of the lungs, haemoptysis is even more common. While interventional procedures help to tide over the crisis and earn valuable time to stabilise a haemorrhaging patient, surgical resection is the definitive management most of the time. This review will endeavour to establish the definition, aetiology, emergency, and definitive management of a patient who presents with haemoptysis.
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Affiliation(s)
- Santhosh Regini Benjamin
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Avinash Anil Nair
- Department of Respiratory Medicine, The Christian Medical College, Vellore, 632004 Tamil Nadu India
| | - Raj Kumar Joel
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Birla Roy Gnanamuthu
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Vinay Murahari Rao
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Shalom Sylvester Andugala
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
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Eckert D, Gaisl T, Guckenberger M, Branco Venancio F, Keane M, Motisi L, Petric P. Successful hemostatic radiotherapy for massive airway bleeding from infectious pulmonary cavity: a case report. Strahlenther Onkol 2023; 199:857-861. [PMID: 37439795 DOI: 10.1007/s00066-023-02110-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Abstract
We present a patient with life-threatening airway bleeding from an infectious pulmonary cavity with limited treatment options. Bronchial artery embolization was unsuccessful. Surgery was not feasible due to compromised lung function. Lung transplant was considered but not endorsed. Palliative hemostatic radiotherapy with 20 Gy in 5 fractions was delivered to the site of bleeding as a last resort. Hemoptysis gradually disappeared within a month and did not recur during the 4‑month follow-up. There were no side effects. We highlight the potential of radiotherapy for massive hemoptysis of infectious etiology, especially in cases with exhausted standard treatment options.
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Affiliation(s)
- David Eckert
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland.
| | - Thomas Gaisl
- Department of Pulmonology, Zürich University Hospital, Zürich, Switzerland
| | | | | | - Michele Keane
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
| | - Laura Motisi
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
| | - Primoz Petric
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
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Wang B, Yao L, Sheng J, Liu X, Jiang Y, Shen L, Xu F, Dai X. Is VATS suitable for lung diseases with hemoptysis? Experience from a hemoptysis treatment center in China. BMC Pulm Med 2023; 23:208. [PMID: 37316807 DOI: 10.1186/s12890-023-02506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Surgery is crucial in the treatment of the potentially fatal pulmonary hemoptysis condition. Currently, most patients with hemoptysis are treated by traditional open surgery (OS). To illustrate the effectiveness of video-assisted thoracic surgery (VATS) for hemoptysis, we developed a retrospective study of surgical interventions for lung disease with hemoptysis. METHODS We collected and then analysed the data, including general information and post-operative outcomes, from 102 patients who underwent surgery for a variety of lung diseases with hemoptysis in our hospital between December 2018 and June 2022. RESULTS Sixty three cases underwent VATS and 39 cases underwent OS. 76.5% of patients were male (78/102). Comorbidities with diabetes and hypertension were 16.7% (17/102) and 15.7% (16/102) respectively. The diagnoses based on postoperative pathology included aspergilloma in 63 cases (61.8%), tuberculosis in 38 cases (37.4%) and bronchiectasis in 1 case (0.8%). 8 patients underwent wedge resection, 12 patients underwent segmentectomy, 73 patients underwent lobectomy and 9 patients underwent pneumonectomy. There were 23 cases of postoperative complications, of which 7 (30.4%) were in the VATS group, significantly fewer than 16 (69.6%) in the OS group (p = 0.001). The OS procedure was identified as the only independent risk factor for postoperative complications. The median (IQR) of postoperative drainage volume in the first 24 h was 400 (195-665) ml, which was 250 (130-500) ml of the VATS group, significantly less than the 550 (460-820) ml of the OS group (p < 0.05). The median (IQR) of pain scores 24 h after surgery was 5 (4-9). The median (IQR) of postoperative drainage tube removal time was 9.5 (6-17) days for all patients, and it was 7 (5-14) days for the VATS group, which was less than 15 (9-20) days for the OS group. CONCLUSION VATS for patients with lung disease presenting with hemoptysis is an effective and safe option that may be preferred when the hemoptysis is uncomplicated and the patient's vital signs are stable.
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Affiliation(s)
- Bing Wang
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Li Yao
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Jian Sheng
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China.
| | - Xiaoyu Liu
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China.
| | - Yuhui Jiang
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Lei Shen
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Feng Xu
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Xiyong Dai
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China.
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Önür ST, Altın S, Akyıl FT, Kara K, Sökücü SN, Özdemir C, Özgül MA, Metin M, Cansever L, Ölçmen A, Kılıçkesmez NÖ. Management of recurrent hemoptysis: a single-center experience. Turk J Med Sci 2022; 52:1872-1880. [PMID: 36945984 PMCID: PMC10390104 DOI: 10.55730/1300-0144.5534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A successful planning methodology for patients with hemoptysis promises overall improvement in patient care. Conducted in a reference center for chest diseases, the present study aims to analyze characteristics and predictors of interventional methods in patients with recurrent hemoptysis. METHODS The present study is a single-center, retrospective observational study. Between 2015 and 2018, 5973 patients with follow-up data until 2021 requiring more than one hospitalization due to recurrent hemoptysis were investigated. Patient characteristics, the amount of hemoptysis, baseline admission parameters, interventional procedures of bronchial artery embolization (BAE), fiberoptic bronchoscopy, rigid bronchoscopy, and surgical resections applied were analyzed according to number of hospitalizations and outcome. RESULTS : Hospital admission numbers were higher in patients with sequela of tuberculosis, bronchiectasis and lung cancer. While lung cancer was the most frequent underlying reason in recurrent admissions, it was determined that as the amount of bleeding increased, the number of admissions also increased to the hospital, and BAE and rigid bronchoscopy were performed more frequently in the groups with less frequent admissions. There was no statistically significance between the amount of bleeding, and the interventional procedure alone or in combination with another procedure (p > 0.05). DISCUSSION In conclusion, patients with certain diseases may experience frequent hospital admissions due to hemoptysis. Recurrent admissions may get better results with BAE and rigid bronchoscopy. We think that these procedures should be preferred in the foreground of suitable patient selection in line with available facilities and experience.
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Affiliation(s)
- Seda Tural Önür
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Sedat Altın
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Fatma Tokgöz Akyıl
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Kaan Kara
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Sinem Nedime Sökücü
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Cengiz Özdemir
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Mehmet Akif Özgül
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Levent Cansever
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Aysun Ölçmen
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Nuri Özgür Kılıçkesmez
- Department of Interventional Radiodiagnostic, İstanbul Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
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Mazi A. Tranexamic Acid Use for Massive Hemoptysis in a Child: A Case Report. Cureus 2022; 14:e28186. [PMID: 36158337 PMCID: PMC9482814 DOI: 10.7759/cureus.28186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/30/2022] Open
Abstract
Massive hemoptysis is a rare life-threatening condition in children. Individuals with non-cystic fibrosis bronchiectasis may present with various degrees of hemoptysis. Therapeutic measures are mainly derived from studies involving adults or various case reports of children with cystic fibrosis. The standard management of massive hemoptysis is limited to invasive bronchoscopy, bronchial artery embolization, and surgical resection. Tranexamic acid (TXA) use is limited to non-massive hemoptysis or as an adjuvant and temporizing measure before definitive treatment. We report the potential use of TXA as an emergency treatment for massive hemoptysis in a 10-year-old boy with non-cystic fibrosis bronchiectasis and chronic infection. The use of systemic TXA (250 mg every eight hours for five days) successfully stopped active bleeding beginning from the first dose and altered the need for invasive interventions. Although he experienced another episode of massive hemoptysis because of pneumonia and pulmonary exacerbation, invasive measures were not required because he responded to systemic TXA immediately. Moreover, no further recurrence of hemoptysis was noted on cessation of TXA and throughout two years of regular follow-up. Therefore, TXA could be considered a non-invasive therapy for children with massive hemoptysis, especially in the absence of standard invasive therapies.
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Abstract
Massive hemoptysis is appropriately defined as life-threatening hemoptysis that causes airway obstruction, respiratory failure, and/or hypotension. Patients with this condition die from asphyxiation, not hemorrhagic shock. Any patient who presents with life-threatening hemoptysis requires immediate treatment to secure the airway and stabilize hemodynamics. Early activation and coordinated response from a multidisciplinary team is critical. Once the airway is secure and appropriate resuscitation is initiated, priorities are to localize the source of the bleeding and gain hemorrhage control. Nonsurgical control of hemorrhage is superior to surgery in the acute situation.
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Affiliation(s)
- Beau Prey
- General Surgery Department, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431, USA.
| | - Andrew Francis
- General Surgery Department, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431, USA
| | - James Williams
- General Surgery Department, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431, USA
| | - Bahirathan Krishnadasan
- Cardiothoracic Surgery, St. Joseph Medical Center, 1802 S. Yakima Avenue, Tacoma, WA 98405, USA
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Charya AV, Holden VK, Pickering EM. Management of life-threatening hemoptysis in the ICU. J Thorac Dis 2021; 13:5139-5158. [PMID: 34527355 PMCID: PMC8411133 DOI: 10.21037/jtd-19-3991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Life-threatening hemoptysis is commonly encountered in the ICU and its management can be challenging even for experienced clinicians. Depending on the etiology and severity, one can tailor the treatment modality and therapeutic intervention(s). The grading of severity of hemoptysis varies greatly in the literature; however, unlike hemorrhage in other scenarios, small amounts of blood can significantly impair oxygenation and ventilation leading to cardiovascular collapse. Importantly, the initial evaluation and management should focus on airway and hemodynamic stabilization along with maintenance of oxygenation and ventilation. In this review, we discuss commonly encountered etiologies, vascular anatomy, diagnostic evaluation, and therapeutic interventions. We examine the evolving trends in etiologies of life-threating hemoptysis over the years. The role of flexible and rigid bronchoscopy as both a diagnostic and therapeutic modality is explored, as well as the use and indications of several bronchoscopic techniques, such as topical hemostatic agents, endobronchial tamponade, and tranexamic acid (TXA). In addition, we assess the use of multi-row detector computed tomography as the initial rapid diagnostic method of choice and its use in planning for definitive treatment. The efficacy and long-term results of bronchial artery embolization (BAE) are evaluated, as well as indications for surgical intervention. Furthermore, the importance of a multidisciplinary approach is emphasized. The necessary interplay between intensivists, consultative services, and radiologists is described in detail and an algorithmic management strategy incorporating the above is outlined. Given the complexity in management of life-threatening hemoptysis, this paper aims to summarize the available diagnostic and therapeutic methods and provide a standardized approach for the management of patients with this often difficult to treat condition.
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Affiliation(s)
- Ananth V Charya
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
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Atchinson PRA, Hatton CJ, Roginski MA, Backer ED, Long B, Lentz SA. The emergency department evaluation and management of massive hemoptysis. Am J Emerg Med 2021; 50:148-155. [PMID: 34365064 DOI: 10.1016/j.ajem.2021.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/09/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Massive hemoptysis is a life-threatening emergency that requires rapid evaluation and management. Recognition of this deadly condition, knowledge of the initial resuscitation and diagnostic evaluation, and communication with consultants capable of definitive management are key to successful treatment. OBJECTIVE The objective of this narrative review is to provide an evidence-based review on the management of massive hemoptysis for the emergency clinician. DISCUSSION Rapid diagnosis and management of life-threatening hemoptysis is key to patient survival. The majority of cases arise from the bronchial arterial system, which is under systemic blood pressure. Initial management includes patient and airway stabilization, reversal of coagulopathy, and identification of the source of bleeding using computed tomography angiogram. Bronchial artery embolization with interventional radiology has become the mainstay of treatment; however, unstable patients may require advanced bronchoscopic procedures to treat or temporize while additional information and treatment can be directed at the underlying pathology. CONCLUSION Massive hemoptysis is a life-threatening condition that emergency clinicians must be prepared to manage. Emergency clinicians should focus their management on immediate resuscitation, airway preservation often including intubation and isolation of the non-bleeding lung, and coordination of definitive management with available consultants including interventional radiology, interventional pulmonology, and thoracic surgery.
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Affiliation(s)
- Patricia Ruth A Atchinson
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Colman J Hatton
- Dartmouth-Hitchcock Medical Center, Section of Critical Care Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Matthew A Roginski
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Elliot D Backer
- Dartmouth-Hitchcock Medical Center, Section of Critical Care Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, United States of America
| | - Skyler A Lentz
- Division of Emergency Medicine and Pulmonary Disease and Critical Care Medicine, The University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
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Fartoukh M, Demoule A, Sanchez O, Tuffet S, Bergot E, Godet C, Andrejak C, Pontier-Marchandise S, Parrot A, Mayaux J, Meyer G, Cluzel P, Sapoval M, Le Pennec V, Carette MF, Cadranel J, Rousseau A, Khalil A, Simon T. Randomised trial of first-line bronchial artery embolisation for non-severe haemoptysis of mild abundance. BMJ Open Respir Res 2021; 8:8/1/e000949. [PMID: 34088727 PMCID: PMC8183216 DOI: 10.1136/bmjresp-2021-000949] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Whereas first-line bronchial artery embolisation (BAE) is considered standard of care for the management of severe haemoptysis, it is unknown whether this approach is warranted for non-severe haemoptysis. Research question To assess the efficacy on bleeding control and the safety of first-line BAE in non-severe haemoptysis of mild abundance. Study design and methods This multicentre, randomised controlled open-label trial enrolled adult patients without major comorbid condition and having mild haemoptysis (onset <72 hours, 100–200 mL estimated bleeding amount), related to a systemic arterial mechanism. Patients were randomly assigned (1:1) to BAE associated with medical therapy or to medical therapy alone. Results Bleeding recurrence at day 30 after randomisation (primary outcome) occurred in 4 (11.8%) of 34 patients in the BAE strategy and 17 (44.7%) of 38 patients in the medical strategy (difference −33%; 95% CI −13.8% to −52.1%, p=0.002). The 90-day bleeding recurrence-free survival rates were 91.2% (95% CI 75.1% to 97.1%) and 60.2% (95% CI 42.9% to 73.8%), respectively (HR=0.19, 95% CI 0.05 to 0.67, p=0.01). No death occurred during follow-up and no bleeding recurrence needed surgery. Four adverse events (one major with systemic emboli) occurred during hospitalisation, all in the BAE strategy (11.8% vs 0%; difference 11.8%, 95% CI 0.9 to 22.6, p=0.045); all eventually resolved. Conclusion In non-severe haemoptysis of mild abundance, BAE associated with medical therapy had a superior efficacy for preventing bleeding recurrences at 30 and 90 days, as compared with medical therapy alone. However, it was associated with a higher rate of adverse events. Trial registration number NCT01278199
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Affiliation(s)
- Muriel Fartoukh
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Médecine intensive réanimation, Sorbonne Université, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Olivier Sanchez
- Service de Pneumologie et Soins Intensifs, HEGP, AP-HP, Innovations Thérapeutiques en Hémostase, INSERM UMRS 1140, Université de Paris, Paris, France
| | - Sophie Tuffet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Research Platform of East of Paris (URC-CRC-CRB), Hôpital Saint Antoine, Paris, France
| | - Emmanuel Bergot
- Department of Pulmonology, Centre Hospitalier Universitaire de Caen, Caen, France
| | | | - Claire Andrejak
- Service de Pneumologie, CHU Amiens-Picardie, UR 4294 AGIR, université Picardie Jules-Verne, 80054 Amiens, France, Amiens, France
| | | | - Antoine Parrot
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Pneumologie et Oncologie thoracique, Centre Constitutif Maladies Pulmonaires Rares, APHP, Paris, France
| | - Julien Mayaux
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), APHP, Paris, France
| | - Guy Meyer
- Université de Paris; Service de Radiologie, HEGP, AP-HP, F-75015 Paris, France, Paris, France
| | - Philippe Cluzel
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Radiologie, Sorbonne Université, Paris, France
| | - Marc Sapoval
- Université de Paris; Service de Radiologie, HEGP, AP-HP, F-75015 Paris, France, Paris, France
| | - Vincent Le Pennec
- Service de radiologie diagnostique et thérapeutique - CHU Avenue de la Cote de Nacre - CS 30001 14033 Caen cedex 9, France, Caen, France
| | - Marie-France Carette
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Radiologie, Sorbonne Université, Paris, France
| | - Jacques Cadranel
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Pneumologie et Oncologie thoracique, Centre Constitutif Maladies Pulmonaires Rares, Sorbonne Université, GRC n°04, Theranoscan, Paris, France
| | - Alexandra Rousseau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Research Platform of East of Paris (URC-CRC-CRB), Hôpital Saint Antoine, Paris, France
| | - Antoine Khalil
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Radiologie, Sorbonne Université, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URC-CRC-CRB), Hôpital St Antoine, Paris, France, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
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Pekçolaklar A, Çitak N, Aksoy Y, Erdoğu V, Sayar A, Metin M. Surgery for Life-Threatening Massive Hemoptysis; Does the Time of Performed Surgery and the Timing of Surgery Affect the Rates of Complication and Mortality? Indian J Surg 2021. [DOI: 10.1007/s12262-021-02867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Early Arterial Embolization and Mortality in Mechanically Ventilated Patients With Hemoptysis: A Nationwide Retrospective Cohort Study. Crit Care Med 2020; 48:1480-1486. [DOI: 10.1097/ccm.0000000000004513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mehta RM, Godara R, Bhat RS, Loknath C, Singla A. A Novel Technique for the Management of Massive Hemoptysis: The Customized Endobronchial Silicone Blocker. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:142-147. [PMID: 32352902 DOI: 10.1177/1556984520904351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Massive hemoptysis (MH) has a high mortality rate. Therapeutic options include bronchoscopy for endobronchial lesions, bronchial artery embolization (BAE), and emergency surgery. Scant options exist for patients who are not candidates for these modalities. Culprit bronchial segment occlusion is an option to prevent "spillover flooding → hypoxia." Applying this concept, we describe a case series of MH control using a novel bronchoscopically inserted customized endobronchial silicone blocker (CESB). We analyzed the safety and efficacy of CESBs in a select subset of patients with MH. METHODS Inclusion criteria were patients with MH who were unstable for surgery/BAE, failed BAE, or relatively contraindicated/refused BAE. CESBs were manufactured on-site by modifying silicone stents, inserted using rigid bronchoscopy and reinforced with glue. The CESB was removed after 6 weeks when possible. A successful outcome was defined as immediate bleeding control with no recurrence after removal. RESULTS Over 4.5 years, 13 episodes of MH in 12 patients meeting the criteria specified earlier were treated with CESBs. Seven of 12 patients had tuberculosis, 4 active and 3 inactive. One patient had mucormycosis, 1 post-lobectomy, 1 endobronchial renal cell carcinoma, 1 fibrosing mediastinitis, and 1 patient had metastatic laryngeal Ca. Eight of 12 patients were taken for primary-CESB placement. Four of 12 patients were sent for BAE, which was unsuccessful, and rescue-CESB was done for definitive management. The success rate, as defined earlier, was 92.3%, with no deaths from MH. CONCLUSIONS Innovative bronchoscopically inserted CESBs are an effective strategy in MH when patients are unstable or fail conventional management.
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Affiliation(s)
- Ravindra M Mehta
- 75438 Department of Interventional Pulmonolgy, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Rakesh Godara
- 75438 Department of Interventional Pulmonolgy, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Rajani Surendar Bhat
- 75438 Department of Interventional Pulmonolgy, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Chakravarthi Loknath
- 75438 Department of Interventional Pulmonolgy, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Abhinav Singla
- 75438 Department of Interventional Pulmonolgy, Apollo Hospitals, Bengaluru, Karnataka, India
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Kathuria H, Hollingsworth HM, Vilvendhan R, Reardon C. Management of life-threatening hemoptysis. J Intensive Care 2020; 8:23. [PMID: 32280479 PMCID: PMC7132983 DOI: 10.1186/s40560-020-00441-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
It is estimated that 5-14% of patients presenting with hemoptysis will have life-threatening hemoptysis, with a reported mortality rate between 9 and 38%. This manuscript provides a comprehensive literature review on life-threatening hemoptysis, including the etiology and mechanisms, initial stabilization, and management of patients. There is no consensus on the optimal diagnostic approach to life-threatening hemoptysis, so we present a practical approach to utilizing chest radiography, computed tomography, and bronchoscopy, alone or in combination, to localize the bleeding site depending on patient stability. The role of angiography and embolization as well as bronchoscopic and surgical techniques for the management of life-threatening hemoptysis is reviewed. Through case presentation and flow diagram, an overview is provided on how to systematically evaluate and treat the bronchial arteries, which are responsible for hemoptysis in 90% of cases. Treatment options for recurrent hemoptysis and definitive management are discussed, highlighting the role of bronchial artery embolization for recurrent hemoptysis.
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Affiliation(s)
- Hasmeena Kathuria
- 1The Pulmonary Center, Boston University School of Medicine, 72 E. Concord St R304, Boston, MA 02118 USA
| | - Helen M Hollingsworth
- 1The Pulmonary Center, Boston University School of Medicine, 72 E. Concord St R304, Boston, MA 02118 USA
| | - Rajendran Vilvendhan
- 2Interventional Radiology, Department of Radiology, Boston Medical Center, Boston, MA USA
| | - Christine Reardon
- 1The Pulmonary Center, Boston University School of Medicine, 72 E. Concord St R304, Boston, MA 02118 USA
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Bronchial Artery Embolisation for Massive Haemoptysis: Immediate and Long-Term Outcomes-A Retrospective Study. Pulm Ther 2020; 6:107-117. [PMID: 32185642 PMCID: PMC7229022 DOI: 10.1007/s41030-020-00112-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Bronchial artery embolisation (BAE) is an established treatment method for massive haemoptysis. The aim of this study is to evaluate the impact of BAE on in-hospital outcomes and long-term survival in patients with massive haemoptysis. Methods Retrospective review of all cases of acute massive haemoptysis treated by BAE between April 2000 and April 2012 with at least a 5 year follow up of each patient. Targeted BAE was performed in cases with lateralising symptoms, bronchoscopic sites of bleeding or angiographic unilateral abnormal vasculature. In the absence of lateralising symptoms or signs, bilateral BAE was performed. Results 96 BAEs were performed in 68 patients. The majority (64 cases, 67%) underwent unilateral procedures. 83 (86.5%) procedures resulted in immediate/short term control of haemoptysis which lasted for longer than a month. The mean duration of haemoptysis free period after embolisation was 96 months. There were three major complications (cardio-pulmonary arrest, paraparesis and stroke). 38 (56%) patients were still alive at least 5 years following their BAE. Benign causes were associated with significantly longer haemoptysis free periods, mean survival 108 months compared to 32 months in patients with an underlying malignant cause (p = 0.005). An episode of haemoptysis within a month of the initial embolisation was associated reduced overall survival (p = 0.033). Conclusion BAE is effective in controlling massive haemoptysis. Long-term survival depends on the underlying pulmonary pathology. Strategies are required to avoid incomplete initial embolisation, which is associated with ongoing haemoptysis and high mortality despite further BAE.
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Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest 2020; 157:77-88. [DOI: 10.1016/j.chest.2019.07.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022] Open
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Ma H, Wang J, Ma X, Zheng S, Ma H, Ge J. Video-assisted thoracoscopic surgery for invasive pulmonary fungal infection in haematology patients. J Thorac Dis 2019; 11:2839-2845. [PMID: 31463113 DOI: 10.21037/jtd.2019.07.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Invasive pulmonary fungal infection in haematological patients sometimes was a difficult problem in diagnosis and treatments. This retrospective study was intended to assess the outcomes of video-assisted thoracoscopic surgery (VATS) in the treatments of this problem. Methods From January 2011 to December 2017, a total of 51 haematological patients underwent VATS for invasive pulmonary fungal infection. We collected and then analyzed potential factors including general conditions, types of haematological diseases, preoperative clinical symptoms, surgical procedures, length of postoperative hospital stay, incidence of postoperative complications and postoperative follow-ups. Results Of the 51 patients, 32 patients underwent video-assisted thoracoscopic wedge resection (62.7%), 6 patients underwent video-assisted thoracoscopic segmentectomy (11.8%) and 13 patients underwent video-assisted thoracoscopic lobectomy (25.5%). The mean operative time was 110.24±38.12 min. The average intraoperative blood loss was 112.35±87.85 mL. The mean postoperative hospital stay was 7.75±3.27 days. Prolonged air leak was found in 6 patients (11.8%), followed by excessive effusion which was found in 4 patients (7.8%). No life-threatening complications or resurgence of fungal infection occurred after surgery. Twenty-seven patients (52.9%) received postoperative antifungal therapies. No 30-day mortality and pulmonary fungal infection recurrence occurred in 6 to 24 months follow-ups. Conclusions VATS is an effective and safe option in management of invasive pulmonary fungal infection among patients with haematological diseases.
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Affiliation(s)
- Han Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jun Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiao Ma
- Department of Haematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Shiying Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Haitao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jinfeng Ge
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Bonnefoy V, Garnier M, Tavolaro S, Antoine M, Assouad J, Fartoukh M, Gibelin A. Bronchial Dieulafoy’s Disease: Visualization of Embolization Particles in Bronchial Aspirate. Am J Respir Crit Care Med 2018; 198:954-955. [DOI: 10.1164/rccm.201711-2184im] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Valentine Bonnefoy
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Réanimation Médico-Chirurgicale
| | - Marc Garnier
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Réanimation Médico-Chirurgicale
| | | | | | - Jalal Assouad
- Service de Chirurgie Thoracique, Groupe Hospitalier des Hôpitaux Universitaires de l’Est Parisien, Faculté de Médecine, Sorbonne Université, Paris, France
| | - Muriel Fartoukh
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Réanimation Médico-Chirurgicale
| | - Aude Gibelin
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Réanimation Médico-Chirurgicale
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Parrot A, Tavolaro S, Voiriot G, Canellas A, Assouad J, Cadranel J, Fartoukh M. Management of severe hemoptysis. Expert Rev Respir Med 2018; 12:817-829. [PMID: 30198807 DOI: 10.1080/17476348.2018.1507737] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Though rare, severe hemoptysis (SH) is associated with a mortality rate exceeding 50% when not managed properly. Areas covered: This paper reviews the recent epidemiological data regarding SH, the role of multidetector computed tomography angiography (MDCTA), and fiberoptic bronchoscopy (FOB) in its management, as well as the value of current treatments. Expert commentary: MDCTA is becoming an essential modality, since it allows determining the location, etiology, and mechanism of the bleeding. FOB can be delayed, except when local control of bleeding is required. Emergency treatment relies on interventional radiology. Both bronchial and non-bronchial arteries should be explored during bronchial arteriography. Surgery must be considered in all operable patients if the cause of hemoptysis persists.
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Affiliation(s)
- Antoine Parrot
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Sebastian Tavolaro
- b Service de Radiologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Guillaume Voiriot
- c Médecine Sorbonne Université , Paris , France.,d Service de Réanimation et USC médico-chirurgicale , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Antony Canellas
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Jalal Assouad
- c Médecine Sorbonne Université , Paris , France.,e Service de chirurgie thoracique et vasculaire , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Jacques Cadranel
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Muriel Fartoukh
- c Médecine Sorbonne Université , Paris , France.,d Service de Réanimation et USC médico-chirurgicale , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
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Voiriot G, Parrot A, Antoine M, Gibelin A, Haddad S, Carette MF, Fartoukh M, Khalil A. Transcatheter embolotherapy of pulmonary artery aneurysms as emergency treatment of hemoptysis in Behcet patients: experience of a referral center and a review of the literature. Intern Emerg Med 2018. [PMID: 29516432 DOI: 10.1007/s11739-018-1817-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hemoptysis is a life-threatening complication of Behcet's disease that is likely related to pulmonary artery aneurysm (PAA). Vascular interventional radiology may offer effective emergency therapeutic option, but has not been thoroughly investigated in this setting. A case series of a French referral center for hemoptysis combined with a literature review of case reports was conducted. Between 1995 and 2016, 12 patients were referred to our center for hemoptysis revealing or complicating the course of Behcet's disease. Pulmonary artery aneurysm (PAA) was the mechanism of hemoptysis in ten patients, nine of whom were treated by a transcatheter embolotherapy. Combining an additional 8 case reports from the literature, 17 patients treated by transcatheter embolotherapy for PAA were analyzed. The duration of the course of Behcet's disease was 22 months [IQR 3-45] at the time of PAA diagnosis. Transcatheter embolotherapy of PAA was successful for immediately controlling hemoptysis in all patients, without major complication except for one. Hemoptysis recurred in seven patients (41%) within 5 months [IQR 1-12]. The use of coils for transcatheter embolotherapy was associated with hemoptysis recurrence. A bronchosystemic hypervascularization related to the previously occluded PAA was the main mechanism of bleeding recurrence, leading to bronchosystemic artery embolization in four patients and surgery in two patients. Behcet's disease-related hemoptysis is mainly due to PAA. Transcatheter embolotherapy should be considered as the first-line emergency treatment for PAA-related hemoptysis, in association with the immunosuppressive regimen. Hemoptysis may recur in half of the cases, involving preferentially a bronchosystemic arterial mechanism.
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Affiliation(s)
- Guillaume Voiriot
- Service de Réanimation Médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020, Paris, France.
- Groupe de Recherche Clinique CARMAS, Faculté de Médecine, Université Paris Est, Créteil, France.
| | - Antoine Parrot
- Service de Réanimation Médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020, Paris, France
| | - Martine Antoine
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aude Gibelin
- Service de Réanimation Médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020, Paris, France
- Groupe de Recherche Clinique CARMAS, Faculté de Médecine, Université Paris Est, Créteil, France
- Faculté de Médecine, Université Pierre et Marie Curie Paris VI, Paris, France
| | - Samuel Haddad
- Service de Radiologie, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie-France Carette
- Faculté de Médecine, Université Pierre et Marie Curie Paris VI, Paris, France
- Service de Radiologie, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Muriel Fartoukh
- Service de Réanimation Médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020, Paris, France
- Groupe de Recherche Clinique CARMAS, Faculté de Médecine, Université Paris Est, Créteil, France
- Faculté de Médecine, Université Pierre et Marie Curie Paris VI, Paris, France
| | - Antoine Khalil
- Service de Radiologie, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Radiologie, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Diderot Paris VII, Paris, France
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Yun JS, Song SY, Na KJ, Kim S, Jang KH, Jeong IS, Oh SG. Surgery for hemoptysis in patients with benign lung disease. J Thorac Dis 2018; 10:3532-3538. [PMID: 30069350 DOI: 10.21037/jtd.2018.05.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hemoptysis can be a life-threatening condition that requires urgent treatment. Surgery still plays an important role in managing this critical situation, although previous reports have reported high postoperative morbidity and mortality rates. We report our experience with surgical resection for hemoptysis caused by benign lung diseases. Methods We reviewed the retrospectively collected data from 94 patients undergoing pulmonary resection for various benign lung diseases with hemoptysis at a single institution from 2010 to 2016. Baseline characteristics, surgical factors, and postoperative outcomes (morbidity and mortality rates) were analyzed. Results The ratio of male to female patients was 1:1, and the mean age was 58.2±11.1 (range, 29-79) years. The etiology of hemoptysis included aspergilloma in 58 patients (61.7%), bronchiectasis in 10, tuberculosis in 7, necrotizing bronchiolitis in 6, and other inflammatory disease in 13. A total of 21 patients (22.3%) underwent emergency operation, and 73 (77.7%) had an elective operation. Pulmonary resection was performed by thoracotomy (n=53, 56.4%) and video-assisted thoracoscopic surgery (VATS) (n=41, 43.6%). Sublobar resection (n=50, 53.2%, segmentectomy in 19 and wedge resection in 31) was performed more often than lobectomy (n=35, 37.2%). Pneumonectomy was performed in 7 patients, and bilobectomy was performed in 2. Postoperative morbidity occurred in 23 patients (24.5%), with prolonged air leak being the most frequent complication (n=14, 14.9%). The in-hospital mortality rate was 3.2% (n=3). Complications were less frequent in patients undergoing an elective operation, VATS, and sublobar resection. Multivariate analysis showed that patients treated with VATS had a decreased risk of postoperative complications (odds ratio, 12.8; 95% confidence interval, 1.29-127.9; P=0.03). Conclusions Surgical resection for hemoptysis in patients with benign lung diseases is the mainstay of effective treatment with acceptable morbidity and mortality rates. If applicable, we recommend elective (planned) sublobar resection using VATS in order to improve postoperative outcomes.
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Affiliation(s)
- Ju Sik Yun
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Keun-Ho Jang
- Department of Occupational and Environmental Medicine, Mokpo Christian Hospital, Jeollanamdo, South Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwang-ju, South Korea
| | - Sang Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwang-ju, South Korea
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Gagnon S, Quigley N, Dutau H, Delage A, Fortin M. Approach to Hemoptysis in the Modern Era. Can Respir J 2017; 2017:1565030. [PMID: 29430203 PMCID: PMC5752991 DOI: 10.1155/2017/1565030] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/14/2017] [Indexed: 11/26/2022] Open
Abstract
Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.
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Affiliation(s)
- Sébastien Gagnon
- Institut Universitaire de Pneumologie et de Cardiologie de Québec, 2725 Ch Ste-Foy, Quebec City, QC, Canada G1V 4G5
| | - Nicholas Quigley
- Institut Universitaire de Pneumologie et de Cardiologie de Québec, 2725 Ch Ste-Foy, Quebec City, QC, Canada G1V 4G5
| | - Hervé Dutau
- Hôpital Nord Marseille, Assistance Publique des Hôpitaux de Marseille, 13915 Chemin des Bourrely, Marseille, France
| | - Antoine Delage
- Institut Universitaire de Pneumologie et de Cardiologie de Québec, 2725 Ch Ste-Foy, Quebec City, QC, Canada G1V 4G5
| | - Marc Fortin
- Institut Universitaire de Pneumologie et de Cardiologie de Québec, 2725 Ch Ste-Foy, Quebec City, QC, Canada G1V 4G5
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Radchenko C, Alraiyes AH, Shojaee S. A systematic approach to the management of massive hemoptysis. J Thorac Dis 2017; 9:S1069-S1086. [PMID: 29214066 DOI: 10.21037/jtd.2017.06.41] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Massive hemoptysis is regarded as a potentially lethal condition that requires immediate attention, and prompt action. Although minor hemoptysis is frequently encountered by most clinicians, massive hemoptysis in far less frequent and most physicians are not prepared to manage this time-sensitive clinical presentation in a systematic and timely fashion. Critical initial steps in management need to be implemented in an expedited fashion, such that patients may have a chance at a more definitive treatment. In this article, we review the definition, vascular anatomy, etiology, diagnostic evaluation, epidemiology and prognostic markers of massive hemoptysis. A systematic approach to management, stabilization and treatment options is followed. An algorithm is proposed for the management of massive hemoptysis and the importance of a multidisciplinary approach is emphasized.
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Affiliation(s)
- Christopher Radchenko
- Department of Pulmonary and Critical Care Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Samira Shojaee
- Departments of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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Zhao XH, Zhang Y, Liang ZY, Zhang SY, Yu WQ, Huang FF. Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis. Indian J Surg 2016; 77:1061-6. [PMID: 27011511 DOI: 10.1007/s12262-014-1145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 07/13/2014] [Indexed: 11/29/2022] Open
Abstract
The objective of this study is to investigate the effects of full airway drainage by fiber bronchoscopy through artificial airway in the treatment of traumatic atelectasis with occult manifestations. From May 2006 to May 2011, 40 cases of occult traumatic atelectasis were enrolled into our prospective study. Group A (n = 18) received drainage by nasal bronchoscope; group B underwent airway drainage by fiber bronchoscopy through artificial airway (n = 22). The effects of treatment were evaluated by the incidence of adult respiratory distress syndrome (ARDS), lung abscess, and the average length of hospital stay. Compared with nasal fiber-optic treatment, airway drainage by fiber bronchoscopy through artificial airway reduced the incidence of ARDS (p = 0.013) and lung abscess (p = 0.062) and shortened the mean length of stay (p = 0.018). Making the decision to create an artificial airway timely and carry out lung lavage by fiber bronchoscopy through artificial airway played a significant role in the treatment of occult traumatic atelectasis.
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Affiliation(s)
- Xue Hong Zhao
- The Department of Emergency Intensive Care Unit, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province China
| | - Yun Zhang
- The Department of General Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province China
| | - Zhong Yan Liang
- The Women's Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang Province China
| | - Shao Yang Zhang
- The Department of General Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province China
| | - Wen Qiao Yu
- The Department of Intensive Care Unit, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang Province China
| | - Fang-Fang Huang
- The Department of Surgical Intensive Care Unit, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province China
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Cordovilla R, Bollo de Miguel E, Nuñez Ares A, Cosano Povedano FJ, Herráez Ortega I, Jiménez Merchán R. Diagnosis and Treatment of Hemoptysis. Arch Bronconeumol 2016; 52:368-77. [PMID: 26873518 DOI: 10.1016/j.arbres.2015.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 12/20/2022]
Abstract
Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located.
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Affiliation(s)
- Rosa Cordovilla
- Servicio de Neumología, Complejo Asistencial Universitario de Salamanca, Salamanca, España.
| | | | - Ana Nuñez Ares
- Servicio de Neumología, Complejo Hospitalario Universitario de Albacete, Albacete, España
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El Hammoumi MM, Slaoui O, El Oueriachi F, Kabiri EH. Lung resection in pulmonary aspergilloma: experience of a Moroccan center. BMC Surg 2015; 15:114. [PMID: 26475478 PMCID: PMC4608121 DOI: 10.1186/s12893-015-0103-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/14/2015] [Indexed: 11/12/2022] Open
Abstract
Background This study was conducted to determine the efficacy of surgery in the treatment of complex aspergilloma comparatively with simple aspergilloma. Methods From January 2006 to December 2014, 115 cases of pulmonary aspergilloma were admitted in our department. One operation on one side was counted as one case and the patients were divided into two groups. In group A: 61 cases of complex aspergilloma. In group B: 50 patients underwent 54 cases of lung resection for simple aspergilloma. People who underwent arteriography and embolization were excluded. Surgical treatment was indicated when 1) recurrent aspergilloma-related hemoptysis, 2) definite simple or complex aspergilloma and 3) a simultaneous bilateral aspergilloma. Results People with complex aspergilloma were big smokers with lower BMI, and had reduced lung function parameters. The main symptoms were repeated hemoptysis, chronic cough, abundant purulent expectoration and respiratory infections. Lobectomy was the most performed indication. In group B, number of wedge resections was larger than group A with statistical significant difference (p = 0.001). In the post-operative course morbidity was higher in group A (16 %) vs (9 %) in group B with statistical difference (p = 0.026). The median follow-up was 30 months (range 19–52 months). The median duration of chest tube drainage was 4 days. The duration of chest tube drainage was longer in the group A (4.7 ± 1.4 versus 2.9 ± 1.3; p = 0.005). The prolonged postoperative air leakage occurred more frequently in group A (14.75 %; versus 1.8 % p = 0.015). In group A, 3 cases and 2 in group B underwent a secondary operation for post operative hemothorax. Bronchopleural fistula occurred exclusively in group A (n = 4). Conclusions The surgical resection should be used in a multidisciplinary approach. Preoperative Interventional therapies could optimize the conditions for the operation. Total surgical resection must be the treatment of choice of localized causative lesions.
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Affiliation(s)
- Mohammed Massine El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Riad 10100, Rabat, Morocco. .,Center of doctoral studies, Faculty of Medecine and Pharmacy, Mohamed V University, Rabat, Morocco.
| | - Omar Slaoui
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Riad 10100, Rabat, Morocco
| | - Fayçal El Oueriachi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Riad 10100, Rabat, Morocco
| | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Riad 10100, Rabat, Morocco.,Center of doctoral studies, Faculty of Medecine and Pharmacy, Mohamed V University, Rabat, Morocco
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Kitajima T, Momose K, Lee S, Haruta S, Ueno M, Shinohara H, Fujimori S, Fujii T, Takei R, Kohno T, Udagawa H. Bronchial bleeding caused by recurrent pneumonia after radical esophagectomy for esophageal cancer. World J Gastroenterol 2015; 21:3394-3401. [PMID: 25805950 PMCID: PMC4363773 DOI: 10.3748/wjg.v21.i11.3394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/08/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
We herein report a case of bronchial bleeding after radical esophagectomy that was treated with lobectomy. A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal carcinoma was referred to our hospital because of sudden hemoptysis. After the esophagectomy, bilateral vocal cord paralysis was observed, and the patient suffered from repeated episodes of aspiration pneumonia. Bronchoscopy revealed hemosputum in the right middle lobe bronchus, and contrast-enhanced computed tomography showed tortuous arteries arising from the right inferior phrenic artery and left subclavian artery toward the right middle lobe bronchus. Although bronchial arterial embolization was performed twice to control the recurrent hemoptysis, the procedures were unsuccessful. Right middle lobectomy was therefore performed via video-assisted thoracic surgery. Engorged bronchial arterys with medial hypertrophy and overgrowth of the small branches were noted near the bronchus in the resected specimen. The patient recovered uneventfully and was discharged on postoperative day 14.
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Kiral H, Evman S, Tezel C, Alpay L, Lacin T, Baysungur V, Yalcinkaya I. Pulmonary resection in the treatment of life-threatening hemoptysis. Ann Thorac Cardiovasc Surg 2015; 21:125-31. [PMID: 25753208 DOI: 10.5761/atcs.oa.14-00164] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Massive hemoptysis is a life threatening situation with high mortality rates. Surgery is effective, however generally an avoided treatment. We report our experience with patients undergoing lung resection for life-threatening hemoptysis. METHODS Records of all surgically treated patients for hemoptysis between June 2009 and June 2012 were reviewed and analyzed retrospectively. RESULTS Anatomical resection was performed on 31 (15.3%) patients out of 203 patients referred to our intensive care unit for life-threatening hemoptysis. 25 (80.6%) were male and six (19.4%) were female; with mean age of 46.4 ± 13.7 (21-77). Pneumonectomy was performed in four (12.9%), lobectomy in 24 (77.4%), segmentectomy in two (6.5%) and bilobectomy in one case. Postoperative complications developed in eight (25.8%), and mortality was observed in two (6.5%) patients. Etiology was bronchiectasis in 13 (42.0%), tuberculosis in eight (25.8%), carcinoma in four (12.9%), aspergilloma in four (12.9%), hydatid cyst in one (3.2%) and lung abscess in one (3.2%) of the cases. CONCLUSIONS Although lung resection in the treatment of massive hemoptysis is accompanied with high morbidity and mortality rates, surgery is the only permanent curative modality. Acceptable results can be achived in the company of a multidisciplinary approach, through avoidance of pneumonectomy and urgent surgery.
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Affiliation(s)
- Hakan Kiral
- Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Department of Thoracic Surgery, Istanbul, Turkey
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Hémoptysie grave. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Razazi K, Parrot A, Khalil A, Djibre M, Gounant V, Assouad J, Carette MF, Fartoukh M, Cadranel J. Severe haemoptysis in patients with nonsmall cell lung carcinoma. Eur Respir J 2014; 45:756-64. [PMID: 25359349 DOI: 10.1183/09031936.00010114] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Severe haemoptysis due to nonsmall cell lung cancer (NSCLC) is considered a grim condition, and there is still scarce data on its characteristics and outcome, despite new imaging and treatment modalities. This retrospective study sought to describe the clinical characteristics, pathophysiology and outcome of NSCLC-related haemoptysis. We included 125 consecutive patients with severe haemoptysis (>100 mL) at admission, 65 (52%) exhibiting squamous cell carcinoma. Tumour cavitation/necrosis was reported in 26 (21%) patients. 52 patients had received anticancer treatment, but none had received anti-angiogenic agents. Severe haemoptysis was related mainly to the bronchial artery (82%), and major pulmonary artery involvement was rare (6.4%). Interventional radiology was performed in 102 patients. Bleeding cessation was achieved in 108 (87%) out of 125 patients. The overall in-hospital and 1-year survival rates were 69% and 30%, respectively. Performance status (PS) ≥ 2 (OR 3.6, 95% CI 1.3-9.6), advanced stage (OR 8.6, 95% CI 2-37) and mechanical ventilation (OR 13, 95% CI 4.5-36) were independent predictors of in-hospital mortality. Performance status ≥ 2 (hazard ratio (HR) 2.4, 95% CI 1.5-3.7), advanced stage (HR 4, 95% CI 2.1-7.7), cancer progression (HR 2, 95% CI 1.01-2.7) and cavitation/necrosis (HR 1.7, 95% CI 1.21-3.2) were independently associated with 1-year mortality. Management of severe haemoptysis related to NSCLC should be improved, given our observed survival rates after hospital discharge.
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Affiliation(s)
- Keyvan Razazi
- AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | - Antoine Parrot
- AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | - Antoine Khalil
- AP-HP, Hôpital Tenon, Service de Radiologie, Pôle Imagerie, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | - Michel Djibre
- AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | - Valerie Gounant
- AP-HP, Hôpital Tenon, Service de Pneumologie - Centre Expert en Oncologie Thoracique, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France AP-HP, Hôpital Tenon, Service de Chirurgie Thoracique, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | - Jalal Assouad
- AP-HP, Hôpital Tenon, Service de Chirurgie Thoracique, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Marie France Carette
- AP-HP, Hôpital Tenon, Service de Radiologie, Pôle Imagerie, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Muriel Fartoukh
- AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Jacques Cadranel
- AP-HP, Hôpital Tenon, Service de Pneumologie - Centre Expert en Oncologie Thoracique, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France Sorbonne Universités, UPMC Univ Paris 06, Paris, France
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Chalumeau-Lemoine L, Khalil A, Prigent H, Carette MF, Fartoukh M, Parrot A. Impact of multidetector CT-angiography on the emergency management of severe hemoptysis. Eur J Radiol 2013; 82:e742-7. [PMID: 23932395 DOI: 10.1016/j.ejrad.2013.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/05/2013] [Accepted: 07/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multidetector CT-angiography (MDCTA) is commonly used in patients with severe haemoptysis requiring admission to intensive care unit. However, the impact of MDCTA on the management of severe haemoptysis in emergency setting is poorly evaluated. METHODS We prospectively compared data provided by clinical bedside evaluation (clinical examination, chest-X-ray and fiberoptic bronchoscopy) to MDCTA data in terms of lateralization, location of the bleeding site, etiology as well as impact on the treatment choice. RESULTS Over a 13-month period, 87 patients (men n=58, median age=61 years, median haemoptysis expectorated volume=180 mL) were included. Etiology was mainly (67%) bronchiectasis, tuberculosis sequelae and tumor. MDCTA and clinical bedside evaluation were equally effective in determining lateralization (87.4% and 93.1%, respectively, p=0.23) and location (85% and 82.7%, respectively, p=0.82) of the bleeding site. MDCTA was significantly more accurate than the clinical bedside strategy in determining the haemoptysis cause (86% and 70%, respectively, p=0.007). Moreover, MDCTA suggested the involvement of systemic arteries as bleeding mechanism in 92% of cases, leading to the modification of the treatment initially considered after bedside evaluation in 21.8% of patients. CONCLUSION MDCTA provides useful information for the management of patients with severe haemoptysis, especially in the treatment choice. Thus, in the absence of emergency fiberoptic bronchoscopy (FOB) requirement for airways management, MDCTA should be the first-line procedure performed in emergency clinical setting.
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Affiliation(s)
- Ludivine Chalumeau-Lemoine
- Service de Pneumologie et Réanimation, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, France
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Alexander GR. A retrospective review comparing the treatment outcomes of emergency lung resection for massive haemoptysis with and without preoperative bronchial artery embolization. Eur J Cardiothorac Surg 2013; 45:251-5. [DOI: 10.1093/ejcts/ezt336] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Paul S, Andrews W, Nasar A, Port JL, Lee PC, Stiles BM, Sedrakyan A, Altorki NK. Prevalence and Outcomes of Anatomic Lung Resection for Hemoptysis: An Analysis of the Nationwide Inpatient Sample Database. Ann Thorac Surg 2013; 96:391-8. [DOI: 10.1016/j.athoracsur.2013.03.097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/12/2013] [Accepted: 03/18/2013] [Indexed: 11/27/2022]
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Affiliation(s)
- Dawn E Jaroszewski
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
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Massard G, Olland A, Santelmo N, Falcoz PE. Surgery for the Sequelae of Postprimary Tuberculosis. Thorac Surg Clin 2012; 22:287-300. [DOI: 10.1016/j.thorsurg.2012.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reck M, Barlesi F, Crinò L, Henschke CI, Isla D, Stiebeler S, Spigel DR. Predicting and managing the risk of pulmonary haemorrhage in patients with NSCLC treated with bevacizumab: a consensus report from a panel of experts. Ann Oncol 2012; 23:1111-1120. [PMID: 22056855 PMCID: PMC3335247 DOI: 10.1093/annonc/mdr463] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/08/2011] [Accepted: 09/12/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Bevacizumab is a monoclonal antibody against vascular endothelial growth factor. Severe pulmonary haemorrhage (PH) is a rare but serious potential adverse event associated with bevacizumab therapy for advanced non-squamous non-small-cell lung cancer (NSCLC). METHODS A panel of expert oncologists, pulmonologists and radiologists reviewed the available data to identify predictive factors for PH in order to help guide physicians using bevacizumab in patients with NSCLC. RESULTS Patients with NSCLC are at an increased risk of PH owing to the underlying disease process. Patients with squamous histology and/or a history of grade ≥ 2 haemoptysis (≥ 2.5 ml per event) should not receive bevacizumab. No clinical or radiological features (including cavitation and central tumour location) reliably predict severe PH in bevacizumab-treated patients. Major blood vessel infiltration and bronchial vessel infiltration, encasement and abutting may predict PH; however, standardised radiological criteria for defining infiltration have not been established. Eligibility for bevacizumab is not affected by patient age, performance status or anticoagulation or antiplatelet therapy. CONCLUSIONS An individualised risk-benefit assessment should be undertaken in all patients with NSCLC in whom bevacizumab is being considered. Further research is required to elucidate the mechanisms underlying PH and the clinical risk factors.
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Affiliation(s)
- M Reck
- Department of Thoracic Oncology, Hospital Grosshansdorf, Grosshansdorf, Germany.
| | - F Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations, Université de la Méditerranée Assistance Publique, Hôpitaux de Marseille, Marseille, France
| | - L Crinò
- Department of Oncology, Hospital Santa Maria della Misericordia, Sant Andrea delle Fratte, Perugia, Italy
| | - C I Henschke
- Department of Radiology, Mount Sinai School of Medicine, New York; Early Diagnosis and Treatment Research Foundation, New York, USA
| | - D Isla
- Medical Oncology Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - S Stiebeler
- Department of Thoracic Oncology, Hospital Grosshansdorf, Grosshansdorf, Germany
| | - D R Spigel
- Sarah Cannon Research Institute, Nashville, USA
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Parrish S, Krimsky W, Browning R, Alabrash M. Novel approaches to the patient with massive hemoptysis. J Community Hosp Intern Med Perspect 2012; 2:14784. [PMID: 23882356 PMCID: PMC3714089 DOI: 10.3402/jchimp.v2i1.14784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/23/2012] [Accepted: 02/01/2012] [Indexed: 11/30/2022] Open
Abstract
Massive hemoptysis is a life-threatening condition with a high mortality when treated conservatively. Several modalities have been described in the treatment of hemoptysis with varying results. Endobronchial therapy has traditionally been performed with rigid bronchoscopy. This requires both specialized training and equipment that is not readily available in many centers. The role of fiberoptic bronchoscopy (FOB) is unclear in these situations but is more widely accessible. We describe three cases of the successful treatment of hemoptysis with FOB. These patients were treated with a combination of techniques described previously in the literature; however, these methods failed to result in cessation of the bleeding. Therefore, we employed alternative strategies not described in the literature, using oxidized regenerated cellulose with FOB alone as well as in conjunction with endobronchial placement of vascular embolization coils. These additional techniques may offer other options when rigid bronchoscopy or other modalities are not readily available.
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Affiliation(s)
- Scott Parrish
- Walter Reed National Military Medical Center, Bethesda, MD, USA
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Mordant P, Badia A, Le Pimpec-Barthes F, Riquet M. [Thoracic surgery in tuberculosis and non-tuberculous mycobacterial diseases]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:77-83. [PMID: 22361064 DOI: 10.1016/j.pneumo.2012.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
Tuberculosis and non-tuberculous mycobacteria are common indications of pleural and mediastinal surgery on a diagnostic intend. However, parenchymatous resection on a curative intend has been proven to benefit to patients with multiresistant tuberculosis in adjunction with prolonged antibiotic treatment. Furthermore, tuberculosis sequelae, i.e. destroyed lung, Aspergillus-infected cavitary tuberculosis, and related hemoptysis are eradicated by a surgical management after careful medical preparation. Finally, surgical resection of localized Mycobacterium avium and M. xenopii infections is associated with a high rate of sputum conversion and a low morbidity.
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Affiliation(s)
- P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20 rue Leblanc, Paris, France
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Fartoukh M, Khoshnood B, Parrot A, Khalil A, Carette MF, Stoclin A, Mayaud C, Cadranel J, Ancel PY. Early prediction of in-hospital mortality of patients with hemoptysis: an approach to defining severe hemoptysis. ACTA ACUST UNITED AC 2011; 83:106-14. [PMID: 22025193 DOI: 10.1159/000331501] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 08/04/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The severity of hemoptysis is usually assessed on the amount of blood expectorated, although no threshold has been agreed upon. Respiratory or hemodynamic failures are additional severity criteria but occur in few cases. OBJECTIVES Early identification of the in-hospital mortality determinants might be helpful to best characterize severe hemoptysis. METHODS This is a retrospective cohort study of consecutive patients with hemoptysis admitted to the ICU of a teaching hospital during a 14-year period. The model for early prediction of in-hospital mortality was developed on a derivation sample (67% of patients) using multiple logistic regression. Calibration and discrimination of the model were tested using the remaining validation sample. A scoring system was developed for clinical use. RESULTS The in-hospital mortality of the 1,087 patients (age 54 years, 71% male) was 6.5% (95% CI 5-8). Chronic alcoholism, cancer or aspergillosis, pulmonary artery involvement, infiltrates involving two quadrants or more on the admission radiograph, and mechanical ventilation at referral predicted independently mortality. The model showed good concordance between predicted and observed probabilities of death and good discrimination (receiver operating characteristic curve area 0.87; 95% CI 0.82-0.92). The model-based score (chronic alcoholism, pulmonary artery involvement, and radiographic patterns, 1 point each; cancer, aspergillosis, and mechanical ventilation, 2 points each) predicted the probability of death as follows: score 0, 1%; score 1, 2%; score 2, 6%; score 3, 16%; score 4, 34%; score 5, 58%; score 6, 79%, and score 7, 91%. CONCLUSIONS Our results provide useful information about the short-term prognosis of patients with hemoptysis, which could help design therapeutic approaches and management plans according to the risk of in-hospital mortality.
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Affiliation(s)
- Muriel Fartoukh
- INSERM, UMR S953, IFR 69, Epidemiological Research on Perinatal Health and Women's and Children's Health, UPMC-University of Paris 6, and Département de Santé Publique, Hôpital Tenon, Assitance Publique-Hôpitaux de Paris, Paris, France.
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Gestion des effets secondaires des thérapies ciblées dans le cancer du rein : effets secondaires pneumologiques. Bull Cancer 2011; 98:S95-S115. [DOI: 10.1684/bdc.2011.1446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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[For a best management of patients with severe hemoptysis]. Rev Mal Respir 2010; 27:1132-4. [PMID: 21163391 DOI: 10.1016/j.rmr.2010.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 11/21/2022]
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Fartoukh M. [Severe haemoptysis: indications for triage and admission to hospital or intensive care unit]. Rev Mal Respir 2010; 27:1243-53. [PMID: 21163400 DOI: 10.1016/j.rmr.2010.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 05/13/2010] [Indexed: 11/26/2022]
Abstract
Recognition of the criteria of severity and the early admission to a referral center play a critical role in the prognosis of severe haemoptysis. The therapeutic management should be undertaken urgently by providing general supportive care, i.e., optimization of oxygenation and haemodynamic stabilization to prevent recurrence of massive bleeding. Interventional radiology has dramatically improved the initial management of severe haemoptysis. Attempts to control haemoptysis by first-line non-surgical methods are necessary to optimize the operative conditions and improve morbidity and mortality. Surgical lung resection remains the treatment of choice in selected patients with localized lesions complicated by severe and/or recurrent episodes of haemoptysis (bronchiectasis) or lesions associated with a high risk of recurrence of bleeding (mycetoma). Haemoptysis related to pulmonary arterial involvement remains a surgical emergency.
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Affiliation(s)
- M Fartoukh
- Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, 4 Rue de la Chine, 75020 Paris, France.
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Ogunrombi A, Onakpoya U, Adewole O, Adesunkanmi A. Challenges in the management of massive haemoptysis in a resource-scarce facility. Trop Doct 2010; 41:8-10. [PMID: 20880949 DOI: 10.1258/td.2010.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Massive hemoptysis is a life-threatening condition requiring multidisciplinary management not often available in resource-deprived countries with a limited range of therapeutic options. Prognosis is poor when salvage surgery is offered during active bleeding.
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Affiliation(s)
- Akinwumi Ogunrombi
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State 220005, Nigeria.
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Abstract
Hemoptysis and thoracic fungal infections are infrequent but challenging problems, especially when encountered in the emergency setting. The evaluation and management of massive and nonmassive hemoptysis is described with special attention to radiologic, bronchcoscopic, and surgical interventions. The important principles of airway control, stabilization, and definitive management are emphasized. Endemic and opportunistic fungal infections are more common than they seem. The role of the surgeon is to assist in diagnosis, evaluate and treat pulmonary nodules, and consider resectional therapy for mycetoma and invasive fungal infections in selected candidates.
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Invited Commentary. Ann Thorac Surg 2009; 88:1565. [DOI: 10.1016/j.athoracsur.2009.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 06/24/2009] [Accepted: 06/30/2009] [Indexed: 11/17/2022]
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