Managing Massive Hemoptysis

Kevin Davidson, Samira Shojaee
Chest 2019 July 30
Massive hemoptysis is a medical emergency with high mortality presenting several difficult diagnostic and therapeutic challenges. The origin of bleeding and underlying etiology often is not immediately apparent and techniques for management of this dangerous condition necessitate an expedient response. Unlike hemorrhage in other circumstances, a small amount of blood can rapidly flood the airways thereby impairing oxygenation and ventilation leading to asphyxia and consequent cardiovascular collapse. Of paramount importance is early control of the patient's airway and immediate isolation of hemorrhage in an attempt to localize and control bleeding. A coordinated team response is essential to guarantee the best chances of patient survival. Prompt control of the airway and steps to limit the spread of hemorrhage take precedence. Bronchial artery embolization, rigid and flexible bronchoscopy and surgery all serve as potential treatment options to provide definitive control of hemorrhage. Several adjunctive therapies described in recent years may also assist in control of bleeding, although their role is less defined in life-threatening hemoptysis and warrant additional studies. In this concise review, we emphasize the steps necessary, for a systematic approach in the management of life-threatening hemoptysis.

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