Medical Minute: Massive Hemoptysis

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July 27, 2017 by dailybolusoflr

By: Shabana Walia


Definition: > 500cc in 24 hours or > 100cc/hour regardless of hemodynamic status


Causes of Massive Hemoptysis:

Bronchiectasis

Tuberculosis (active or prior)

Aspergillus

Lung Abscess

Immunologic Lung Diseases

Mitral Stenosis

Pulmonary embolism

Vessel involved: Bronchial Arteries (90%) > Pulmonary Arteries (5%)


Risk Factors that Predict Mortality:

Volume of Hemoptysis

History of CHF

Underlying Pulmonary Disease

Infiltrates on CXR

Bleeding from PA

Cancer

Aspergillosis

Alcoholism


Initial Steps:

Identify which site is bleeding and place patient with bleeding lung in the dependent position

Intubate when: hemodynamic instability, poor gas exchange, persistent dyspnea, altered mental status, or patient with poor cardiopulmonary reserve

If profuse, can attempt to mainstem intubate the non-bleeding lung. This would also be an indication for a double-lumen ETT

Consider transfusion and correct all coagulopathies

Have a low threshold to perform a chest CT with IV contrast


Consult Teams and Therapeutic Interventions:

Pulmonology – Flexible or rigid bronchoscopy

Interventional Radiology – Arterial embolization

Thoracic Surgery – Operative repair


References:

Cahill, B. C., and D. H. Ingbar. 1994. “Massive Hemoptysis. Assessment and Management.” Clinics in Chest Medicine 15 (1): 147–67.

Fartoukh, Muriel, Babak Khoshnood, Antoine Parrot, Antoine Khalil, Marie-France Carette, Annabelle Stoclin, Charles Mayaud, Jacques Cadranel, and Pierre Yves Ancel. 2012. “Early Prediction of in-Hospital Mortality of Patients with Hemoptysis: An Approach to Defining Severe Hemoptysis.” Respiration; International Review of Thoracic Diseases 83 (2): 106–14.

Jean-Baptiste, Eddy. 2000. “Clinical Assessment and Management of Massive Hemoptysis.” Critical Care Medicine 28 (5): 1642–47.

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