HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jacques Jougon Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jougon, J. Articles by Velly, J. F. Search for Related Content PubMed PubMed Citation Articles by Jougon, J. Articles by Velly, J. F. Related Collections Anesthesia Lung - cancer Lung - other

Eur J Cardiothorac Surg 2002;22:345-351
© 2002 Elsevier Science NL

Massive hemoptysis: what place for medical and surgical treatment

^a Department of Thoracic Surgery, Haut-Lévêque Hospital, Bordeaux University Hospital, avenue de Magellan, 33604 Pessac, France
^b Department of Ear-Nose and Throat and cervico-facial surgery, General Hospital, University Hospital, 21033 Dijon, France
^c Department of Intensive Care Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, avenue de Magellan, 33604 Pessac, France
^d Department of Radiology, Haut-Lévêque Hospital, Bordeaux University Hospital, Avenue de Magellan, 33604 Pessac, France

Received 30 January 2002; received in revised form 19 May 2002; accepted 23 May 2002.

* Corresponding author. Service de Chirurgie Thoracique, Hôpital du Haut-Lévêque, 33604, Pessac, France. Tel.: +33-556555009; fax: +33-556555021
e-mail: jacques.jougon{at}chu-bordeaux.fr

Objective: The objective of the study was to define timing of surgical treatment in management of massive hemoptysis. Methods: We performed a retrospective review of all patients admitted for massive hemoptysis in the intensive care unit of our thoracic surgery department. Treatment was managed according to the patient's status, the etiology of bleeding, the findings of bronchoscopy and computed tomographic scan. Therapeutic measures available were medical treatment, tracheal intubation (single or double lumen tube), interventional endoscopy, arterial embolisation and surgical treatment. Results: Between September 1996 and December 2001, 43 patients were treated (nine females and 34 males with mean age of 54 years, range from 32 to 79). The mean red cell blood transfusion per patient was 1.57 Units. The patients were classified into three groups: Group 1, 11 patients were operated on immediately close to the bleeding crise (five pneumonectomy and six lobectomy); Group 2, five patients for whom operation was delayed from the 7th to the 22nd day after cessation of bleeding (five lobectomy); Group 3, 27 patients were treated by non-surgical methods (medical treatment, endobronchial treatment, percutaneous embolisation). Fifteen patients underwent an arterial embolization, which was complete in 13 cases. Among the five patients of group 2, cessation of bleeding was obtained by bronchial embolisation in four cases. Considering the whole series, 10 (23%) patients died: three (19%) patients in group 1, zero in group 2, seven (26%) in group 3. In two patients who were suffering from tumor necrosis, hemoptysis relapsed leading to death. Conclusion: Emergency thoracotomy for massive hemoptysis is at high risk. In case of bleeding from the arterial bronchial vessels, embolization may enable to postpone surgery and operate secondarily. In case of bleeding from the pulmonary vessels (tumor necrosis), surgical treatment must be immediate. An algorithm for management is proposed.

Key Words: Hemoptysis • Respiratory distress • Bronchial carcinoma • Tuberculosis • Bronchectasis • Bronchial arteries

This article has been cited by other articles:

				H. C.N. Tien, M. R.C. Gough, R. Farrell, and J. Macdonald Successful Use of Recombinant Activated Coagulation Factor VII in a Patient with Massive Hemoptysis From a Penetrating Thoracic Injury Ann. Thorac. Surg., October 1, 2007; 84(4): 1373 - 1374. [Abstract] [Full Text] [PDF]

				A. Valipour, A. Kreuzer, H. Koller, W. Koessler, and O. C. Burghuber Bronchoscopy-Guided Topical Hemostatic Tamponade Therapy for the Management of Life-Threatening Hemoptysis Chest, June 1, 2005; 127(6): 2113 - 2118. [Abstract] [Full Text] [PDF]

				A. Ayed Pulmonary resection for massive hemoptysis of benign etiology Eur. J. Cardiothorac. Surg., November 1, 2003; 24(5): 689 - 693. [Abstract] [Full Text] [PDF]

				M. Metin, A. Turna, A. Sayar, and A. Gurses Prompt surgery for massive hemoptysis: more acceptable than it was reported Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 647 - 647. [Full Text] [PDF]

				J. Jougon, F. Delcambre, and J.-F. Velly Reply to Metin et al. Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 648 - 648. [Full Text] [PDF]