Management of Massive Hemoptysis: A Single Institution Experience

Abstract

Introduction: Definition of massive hemoptysis is unclear: criteria range from 100cc /day to 1000cc over a few days. Massive hemoptysis is seen in 1.5 % of all hemoptysis cases. Deaths occurring by exsanguination or asphyxiation from flooding of the alveoli with blood and intractable hypoxemia. The 3 principles of management of hemoptysis consist: 1) maintain airway patency and oxygenation, 2) localize the source of bleeding, 3) control hemorrhage. Consider surgery for lateralized uncontrollable massive hemoptysis unresponsive to other measures or as a definitive therapy in patients whose hemoptysis and general medical condition have stabilized. Objective: Analyses of our experience in treatment of 24 patients with severe hemoptysis for in single thoracic surgery Unit in SU "Shefqet Ndroqi" Tirana, Albania. Material and Methods: In a 5-years period 2009-2013, twenty-four patients were admitted in our hospital with massive hemoptysis. All patients are estimated by: Physical examination, CXR, CT Chest, Bronchoscopy and Arteriography. Fifteen 15 (62%) patients received surgical resection as a definitive therapy. Results: Of twenty-four patients enrolling in the study 18 were males and 6 females, mean age 54.9 ± 13,7 years. The underlying pathology included bronchiectasis (n=5), active tuberculosis (n=9), pneumomycosis (n=7), lung cancer (n=2) and pulmonaryhydatic cyst(n=1). Hemoptysis ceased with conservative management in 9 patients (38%) only. Fifteen 15 (62%) patients received surgical resection. The procedures included lobectomy (n=13), bilobectomy (n=1) and pneumonectomy (n=1). The in-hospital mortality after surgery was 4.1% (1) patient. Redu-thoracotomy and right axillary open window in one patient. Postoperative morbidity occurred in 4 patients, including prolonged ventilatory support, bronchopleural fistulae, empyema and myocardial infarction. Conclusions: The clinical outcome for massive hemoptysis reflects the generalized nature of a destructive disease process involving both lungs and a limited respiratory reserve. Surgery is associated with high risk of morbidity and mortality, and should be performed only in selected patients.

Keywords: masive Hemoptysis, Chest, Bronchoscopy and Arteriography, bronchopleural fistulae, empyema and myocardial infarction.