Hemoptysis can be differentiated into mild or massive and the etiology may vary depending on the patient population studied. We conducted a retrospective analysis on the etiology of hemoptysis and the outcomes of patients with hemoptysis while receiving mechanical ventilation in the Intensive Care Unit (ICU).
We identified 115 patients diagnosed with hemoptysis during their ICU-stay (combined Medical/Surgical) at the University of Alberta Hospital between the years 1990 to 1995. Hemoptysis was characterized by site (local or diffuse) and by amount - minor (<400 ml/24h) or massive (>400 ml/24h). Outcome was analyzed with respect to medical (including bronchus balloons and bronchial artery embolization) or surgical management (rigid bronchoscopy and thoracotomy). A comparison between groups was done using students t-test; identification of factors associated with mortality was performed using a logistic regression model. The null hypothesis was rejected for p<0.05.
Overall mortality was 24% in patients admitted with hemoptysis (n=42) compared to 36% in patients who developed the condition while in the ICU (n=73). Massive hemoptysis was more frequent in the first group (63% vs. 24%, p< 0.01). Mortality was 45% for patients with diffuse hemoptysis and 20.3% for those with localized bleeding (p< 0.01). The most common factors associated with hemoptysis were hematological abnormalities (58%), sepsis (56%) and congestive heart failure (CHF) (24%). Thrombocytopenia is the only independent risk factor associated with mortality in our study. Surgical treatment of hemoptysis was performed in 32 patients (mortality 32%) whereas the rest received medical therapy (mortality 33%). There was a trend towards lower mortality in those patients suffering from massive hemoptysis who were treated with a surgical intervention (p=0.058).
Mortality is significantly higher in ICU patients who suffer from diffuse hemoptysis compared to those who have localized bleeding. Localized hemoptysis is more likely to be amenable to surgical treatment.
Our study suggests that for ICU patients suffering from massive but localized hemoptysis, surgical intervention has a better outcome than medical management.
J.M. Walz, None.