The etiology of hemoptysis in mechanically ventilated ICU patients includes a wide spectrum of disorders. We evaluate the utility of fiberoptic bronchoscopy when used to identify and diagnose the bleeding source and potentially achieve hemostasis in such patients.
A retrospective review of medical records of ICU patients who developed hemoptysis while on mechanical ventilation at a tertiary-care, 700-bed teaching hospital. All bronchoscopies done from April 1998 to December 2003 were reviewed.
Seventy-one bedside fiberoptic bronchoscopies were performed in 56 ICU patients on mechanical ventilation. Mean age was 55 years, 35 were male. The amount of hemoptysis ranged from persistent blood-streaked sputum to massive. The bleeding source was localized during 66.2% (n=47) of all bronchoscopies, although additional diagnostics (radiology, repeat bronchoscopy, etc) after bronchoscopy were required in 23% (n=16) of cases. Bronchoscopic findings were consistent with the final consensus etiology of hemoptysis in 77% of cases (n=55). Only in 42% (n=30) of cases was the clinical impression prior to bronchoscopy consistent with the final diagnosis of the cause for hemoptysis. Etiologies of hemoptysis included: pneumonia, coagulopathy, suction trauma, pulmonary edema, trauma, neoplasm, pulmonary embolism, and granulation tissue. Diagnostic samples taken during 23 bronchoscopies yielded positive results in 17 cases.Patients underwent at least one therapeutic intervention after 51% of bronchoscopies (anticoagulation discontinued, antibiotics changed, transfusion, etc). Bronchoscopic interventions were performed in 8 cases (11%), including deployment of fogarty balloon, application of neosynephrine, repositioning of endotracheal tube, and removal of blood clots. Minor complications were evident in 3 (4%) cases within 24 hours after bronchoscopy: transient desaturation once, transient hypotension twice. The transient hypotension resolved spontaneously, while the desaturation required slight endotracheal tube repositioning.
Localization of the source of hemoptysis and determination or confirmation of the etiology of hemoptysis is frequently achieved bronchoscopically, although intraoperative treatment is seldom done.
Bedside fiberoptic bronchoscopy is a safe diagnostic tool with adequate diagnostic yield when used for the evaluation of hemoptysis in mechanically ventilated patients in the ICU.
Maya Juarez, None.