Massive Airway Hemorrhage

Massive Hemoptysis – many definitions but better measured by the magnitude of the functional effects of the hemoptysis rather than the amount.  What is the current clinical impact on the patient?

Assess:

  • Need for Hospitalization
  • Need for Intubation
  • Need for Transfusion
  • Degree of hypoxemia and hypotension

Causes

  1.  Proximal airway bleeding – malignant tumors(by far most common).  Important to identify because interventional pulmonary techniques are very useful, and a rigid bronchoscope reaches this area, making it the instrument of choice
  2. Distal airway bleeding – Many causes, virtually every lung pathology can lead to bleeding. Implications – bleeding cannot always be managed by interventional pulmonary methods