Version June 2024
This figure summarizes our suggested approach to management patients with life-threatening hemoptysis (sometimes known as massive). We define hemoptysis as life-threatening if estimated blood loss is more than approximately 200 mL within 24 hours for an adolescent and/or if there is evidence of hemodynamic instability (tachycardia, hypotension), abnormal gas exchange, difficulty maintaining a patent airway, or very brisk bleeding. Volume estimates defining massive hemoptysis in smaller children are lacking.
Patients with life-threatening hemoptysis should be managed in a setting where personnel and equipment for advanced airway management are available. Initial stabilization is typically in an emergency department and subsequent management in an intensive care setting, operating room, or interventional radiology suite. Consultations for a patient with massive hemoptysis typically include anesthesia, surgery, interventional radiology, pulmonology, otorhinolaryngology (ENT), and/or gastroenterology (to exclude hematemesis).CBC: complete blood count; CT: computed tomography; BPAP: bilevel positive airway pressure; IV: intravenous; NSAIDs: nonsteroidal antiinflammatory drugs; PT: physiotherapy; CF: cystic fibrosis; BAE: bronchial artery embolization; ECMO: extracorporeal membrane oxygenation; PAH: pulmonary artery hypertension; ENT: ear, nose, and throat specialist.
* Most patients who are hemodynamically unstable also have some respiratory compromise and will require intubation. If not, intubation is often required for subsequent procedures such as BAE.
¶ The decision to perform either of these procedures and the choice between them are complex and depend on the underlying condition, clinical stability of the patient, and availability of appropriately trained procedurists. The decision should be individualized and made collaboratively between the critical care team, pediatric pulmonologist, interventional radiologist, and other consulting services. For patients with CF and massive hemoptysis who are clinically unstable, a consensus panel suggests proceeding directly to BAE rather than evaluating with bronchoscopy prior to BAE[1]. Proceeding directly to BAE also may be appropriate for selected patients without CF if the bleeding source is known or localized by imaging[2]. Refer to UpToDate topic on hemoptysis in children for additional details.
Δ Hemostasis interventions at bronchoscopy may include infusion of cold saline or epinephrine, laser treatment, or balloon tamponade.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
