EXSANGUINATING HEMOPTYSIS

  • 1 January 1982
    • journal article
    • research article
    • Vol. 84  (6) , 829-833
Abstract
Massive hemoptysis (600 ml/24 h) results in a mortality of > 50%. Pulmonary resections (74) were performed in patients with massive hemoptysis in the last 15 yr with a mortality of 13%. The mortality correlated with the rate and the amount of recorded blood loss before the operation. From this experience, a subgroup of patients was identified with such massive hemoptysis that life was threatened by exsanguination. Of the patients, 24 lost > 1000 ml of blood at a rate of at least 150 ml/h, before the pulmonary resection was performed. The bleeding site was always identified by bronchoscopy. All patients were treated by resection of the bleeding lung parenchyma. Several methods were used to avoid the patient''s drowning in his own blood during the operation. In 5 patients, a double-lumen endotracheal tube was used. Two died of suffocation during the procedure and another died of respiratory and liver failure. In 4 patients, single-lung ventilation with an endotracheal tube in the left main bronchus was used. All 4 survived. In another 10 patients a bronchial blocker (No. 9 Fogarty balloon venous catheter) was used to stop bleeding. Two patients died of renal failure and gastrointestinal bleeding, respectively, but none had aspiration problems. In 5 additional patients, a regular endotracheal tube was used. One patient died of massive aspiration. Apparently, bleeding from the left lung and right lower lobe should be controlled by intubation of the left bronchus. Patients with exsanguinating hemoptysis should be treated, when possible, by pulmonary resection. A survival rate of 75% was obtained in these patients.