Pulmonology Procedures |

Life Threatening Hemoptysis in ICU — An Indian Experience FREE TO VIEW

Vivek Nangia*, MD; Paramez Ayyappath, MD; Hemant Tewari, MD; R. Chatterji, MD; Ak Singh, MD
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Fortis Hospital, New Delhi, India

Chest. 2012;142(4_MeetingAbstracts):910A. doi:10.1378/chest.1386969
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SESSION TYPE: Bronchoscopy and Interventional Procedures Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Massive hemoptysis is a fearful catastrophe associated with high morbidity & mortality. Although surgical resection & embolotherapy have been considered as definitive procedures, early bronchoscopy and the development of various endobronchial procedures like endobranchial balloon and glue tamponading have revolutionized the management of “life threatening hemoptysis.”

METHODS: We carried out a retrospective analysis of patients admitted to the Intensive Care Unit with massive hemoptysis(defined as blood loss of > 300ml in 24 hours) from January 2002 to December 2011. After initial stabilization, a videobronchoscopy was performed in all these patients within the first 24 hours. The etiology, site of bleed (localized or diffuse), therapeutic procedures and outcome was analysed in these cases.

RESULTS: A total of 72 patients were studied (52 males, 20 females). Fibrocavitatory disease (n=27, 37.5%) and active tuberculosis (n= 26, 36.1%) were the major causes identified. Other causes included sepsis with DIC(n=6, 8.3%), carcinoma lung (n=4, 5.5%), aspergilloma (n=3, 4.16%),bronchiectasis (n=2, 22.6%), lymphoma, blastomycosis, paragonimiasis and thymic teratoma (1 each). Bronchoscopic detection of site of bleed was 100 % in all except sepsis where diffuse bleed was noted., Balloon tamponading(n=49,68%), glue therapy(n=6, 8.3%) & Selective intubation (n=6, 8.3%) were performed as initial procedures with immediate control of hemoptysis achieved in 96%, 33.3% and 100% patients respectively. Bronchial artery embolization (n=40, 55%) and surgery (n=3, 4.16%) were performed as more definitive procedures with success rates of 96% and 100% respectively. 10 patients underwent no intervention. 8 patients (11.1%) expired, 6 among non-intervention group and 2 patients with aspergilloma despite endobronchial tamponading

CONCLUSIONS: Early bronchoscopy helps in identifying the site of bleeding and deciding the further course of management. It also facilitates accurate sampling of tissues for the etiological diagnosis. Endobronchial tamponading serves as a rapid, simple, safe and effective method in controlling life threatening hemoptysis.

CLINICAL IMPLICATIONS: In life threatening hemoptysis, endobronchial and endovascular procedures should be considered early. The chances of successful hemostasis are high when it is done early.

DISCLOSURE: The following authors have nothing to disclose: Vivek Nangia, Paramez Ayyappath, Hemant Tewari, R. Chatterji, Ak Singh

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Fortis Hospital, New Delhi, India




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