Acute Pulmonary Hemorrhage: Multidisciplinary Perspectives in Respiratory, Anesthesia, and Emergency Care
Abstract
Background: Pulmonary hemorrhage is a life-threatening condition characterized by bleeding from the lower respiratory tract, most often presenting as hemoptysis. Its severity ranges from minor, self-limited episodes to massive hemorrhage causing airway obstruction, respiratory failure, and hemodynamic collapse. The bronchial arterial circulation accounts for the majority of clinically significant cases, and etiologies vary globally, including tuberculosis, bronchiectasis, malignancy, and infectious or inflammatory lung diseases.
Aim: This review aims to provide a multidisciplinary overview of the etiology, epidemiology, pathophysiology, evaluation, and management of pulmonary hemorrhage, emphasizing contemporary evidence-based clinical practices.
Methods: The manuscript synthesizes findings from major cohort studies, prospective analyses, and current clinical guidelines. It integrates data on causes, regional variations, diagnostic strategies, interventional options, and outcomes to present a comprehensive overview for respiratory, anesthesia, and emergency care teams.
Results: Evidence shows that massive hemoptysis comprises a small proportion of total cases but carries high mortality if not promptly managed. CT imaging provides superior diagnostic accuracy compared to chest radiography and often surpasses bronchoscopy for localization. Modern bronchial artery embolization achieves initial hemostasis in up to 90% of patients, though rebleeding occurs in approximately 30%. Airway stabilization, bronchoscopic interventions, anticoagulation reversal, and adjunctive therapies such as tranexamic acid are effective components of acute management.
Conclusion: Pulmonary hemorrhage requires rapid diagnosis, airway protection, multidisciplinary coordination, and timely interventional therapy. Advances in imaging, bronchoscopy, and embolization have significantly reduced mortality, but recurrence and complications remain substantial concerns.
Full text article
References
Karlafti E, Tsavdaris D, Kotzakioulafi E, Kougias L, Tagarakis G, Kaiafa G, Netta S, Savopoulos C, Michalopoulos A, Paramythiotis D. Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies. J Pers Med. 2023 Nov 26;13(12)
Radchenko C, Alraiyes AH, Shojaee S. A systematic approach to the management of massive hemoptysis. J Thorac Dis. 2017 Sep;9(Suppl 10):S1069-S1086.
Prey B, Francis A, Williams J, Krishnadasan B. Evaluation and Treatment of Massive Hemoptysis. Surg Clin North Am. 2022 Jun;102(3):465-481.
Fartoukh M, Khoshnood B, Parrot A, Khalil A, Carette MF, Stoclin A, Mayaud C, Cadranel J, Ancel PY. Early prediction of in-hospital mortality of patients with hemoptysis: an approach to defining severe hemoptysis. Respiration. 2012;83(2):106-14.
Mondoni M, Carlucci P, Job S, Parazzini EM, Cipolla G, Pagani M, Tursi F, Negri L, Fois A, Canu S, Arcadu A, Pirina P, Bonifazi M, Gasparini S, Marani S, Comel AC, Ravenna F, Dore S, Alfano F, Sferrazza Papa GF, Di Marco F, Centanni S, Sotgiu G. Observational, multicentre study on the epidemiology of haemoptysis. Eur Respir J. 2018 Jan;51(1)
Tsoumakidou M, Chrysofakis G, Tsiligianni I, Maltezakis G, Siafakas NM, Tzanakis N. A prospective analysis of 184 hemoptysis cases: diagnostic impact of chest X-ray, computed tomography, bronchoscopy. Respiration. 2006;73(6):808-14.
Singer ED, Faiz SA, Qdaisat A, Abdeldaem K, Dagher J, Chaftari P, Yeung SJ. Hemoptysis in Cancer Patients. Cancers (Basel). 2023 Sep 28;15(19)
Cahill BC, Ingbar DH. Massive hemoptysis. Assessment and management. Clin Chest Med. 1994 Mar;15(1):147-67.
Zatakia J, Shojaee S. Calcified Lymph Node. An Unusual Cause of Hemoptysis. Ann Am Thorac Soc. 2015 Aug;12(8):1240-2.
Rasmussen V, Moore WD. On Hæmoptysis, Especially When Fatal, in Its Anatomical and Clinical Aspects. Edinb Med J. 1868 Dec;14(6):486-503.
Boulay F, Berthier F, Sisteron O, Gendreike Y, Blaive B. Seasonal variation in cryptogenic and noncryptogenic hemoptysis hospitalizations in France. Chest. 2000 Aug;118(2):440-4.
Herth F, Ernst A, Becker HD. Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin. Chest. 2001 Nov;120(5):1592-4.
Maucotel AL, Kolenda C, Laurent F, Tristan A. Staphylococcus aureus: No ticket for the Paris 2024 Olympic Games! Infect Dis Now. 2024 Jun;54(4S):104882.
Yendamuri S. Massive Airway Hemorrhage. Thorac Surg Clin. 2015 Aug;25(3):255-60.
Gagnon S, Quigley N, Dutau H, Delage A, Fortin M. Approach to Hemoptysis in the Modern Era. Can Respir J. 2017;2017:1565030.
Dweik RA, Stoller JK. Role of bronchoscopy in massive hemoptysis. Clin Chest Med. 1999 Mar;20(1):89-105.
Revel MP, Fournier LS, Hennebicque AS, Cuenod CA, Meyer G, Reynaud P, Frija G. Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis? AJR Am J Roentgenol. 2002 Nov;179(5):1217-24.
Millar AB, Boothroyd AE, Edwards D, Hetzel MR. The role of computed tomography (CT) in the investigation of unexplained haemoptysis. Respir Med. 1992 Jan;86(1):39-44.
Set PA, Flower CD, Smith IE, Chan AP, Twentyman OP, Shneerson JM. Hemoptysis: comparative study of the role of CT and fiberoptic bronchoscopy. Radiology. 1993 Dec;189(3):677-80.
Khalil A, Soussan M, Mangiapan G, Fartoukh M, Parrot A, Carette MF. Utility of high-resolution chest CT scan in the emergency management of haemoptysis in the intensive care unit: severity, localization and aetiology. Br J Radiol. 2007 Jan;80(949):21-5.
Solomonov A, Fruchter O, Zuckerman T, Brenner B, Yigla M. Pulmonary hemorrhage: A novel mode of therapy. Respir Med. 2009 Aug;103(8):1196-200.
Bair AE, Doherty MJ, Harper R, Albertson TE. An evaluation of a blind rotational technique for selective mainstem intubation. Acad Emerg Med. 2004 Oct;11(10):1105-7.
Kovacs G, Sowers N. Airway Management in Trauma. Emerg Med Clin North Am. 2018 Feb;36(1):61-84.
Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. 2018 Dec;154(6):1379-1384.
Garzon AA, Gourin A. Surgical management of massive hemoptysis. A ten-year experience. Ann Surg. 1978 Mar;187(3):267-71.
Chen J, Chen LA, Liang ZX, Li CS, Tian Q, Yang Z, Jiang YW, She DY. Immediate and long-term results of bronchial artery embolization for hemoptysis due to benign versus malignant pulmonary diseases. Am J Med Sci. 2014 Sep;348(3):204-9.
Fruchter O, Schneer S, Rusanov V, Belenky A, Kramer MR. Bronchial artery embolization for massive hemoptysis: long-term follow-up. Asian Cardiovasc Thorac Ann. 2015 Jan;23(1):55-60.
Kaufman CS, Kwan SW. Bronchial Artery Embolization. Semin Intervent Radiol. 2022 Jun;39(3):210-217.
Fernando HC, Stein M, Benfield JR, Link DP. Role of bronchial artery embolization in the management of hemoptysis. Arch Surg. 1998 Aug;133(8):862-6.
Andréjak C, Parrot A, Bazelly B, Ancel PY, Djibré M, Khalil A, Grunenwald D, Fartoukh M. Surgical lung resection for severe hemoptysis. Ann Thorac Surg. 2009 Nov;88(5):1556-65.
Hirshberg B, Biran I, Glazer M, Kramer MR. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest. 1997 Aug;112(2):440-4.
Authors
Copyright (c) 2024 Khalid Abdullah Mohammed Bani Humayyim, Qusai Jubarah Aljubarah, Yahia Ali Mashragi, Abdullah Ibrahim Almadhari, Yasser Emad Alharbi, Bader A. Alfawzan, Ameerah Abdullah Aleisawi, Hadi Ali Mobarki, Yazeed Abdullah Salem Alhumaidi, Homoud Mohammed Alsubaie, Ahmed Hulayyil Alruwaili, Abdullah Hussain Alyousef, Noor Barakah Flaihe ALShmmary
This work is licensed under a Creative Commons Attribution 4.0 International License.