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(Chest. 2000;118:1431-1435.)
© 2000 American College of Chest Physicians

Managing Life-Threatening Hemoptysis*

Has Anything Really Changed?

Edward F. Haponik, MD, FCCP; Alan Fein, MD, FCCP and Robert Chin, MD, FCCP

* From the Department of Internal Medicine (Dr. Haponik), Section on Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Wake Forest University School of Medicine (Dr. Chin), Winston-Salem, NC; and North Shore Hospital (Dr. Fein), New York, NY.

Correspondence to: Edward F. Haponik, MD, FCCP, Professor of Medicine, Director of Clinical Operations, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Room 301, Baltimore, MD 21205

Study objectives: To delineate current chest clinicians’ approaches to the management of patients with life-threatening hemoptysis.

Design: Survey during a computer-assisted interactive continuing medical education presentation.

Setting: The 1998 American College of Chest Physicians (ACCP) Annual Scientific Assembly.

Participants: Chest clinicians attending the respiratory emergency symposium.

Results: Most clinicians (86%) had cared for patients with life-threatening hemoptysis, and 28% had cared for patients with fatal events during the previous year. Those clinicians favored management in the ICU setting (95%) with early endotracheal intubation (85%), and they tended to use a large-bore, single-lumen endotracheal tube (57%). The majority (64%) favored the early performance of diagnostic bronchoscopy during the first 24 h. Most clinicians (79%) used the flexible instrument, a higher frequency than respondents at a similar symposium on hemoptysis at the 1988 ACCP meeting (48%; p < 0.0001). Most current clinicians (77%) had experience with endobronchial measures to control bleeding, but few (14%) found them to be consistently worthwhile. Chest CT scanning was often helpful in diagnosis (55%). In their management of bleeding, half of these clinicians favored the use of interventional angiography, even in operable patients, which is a substantial change from 1988 when 23% had favored this approach (p < 0.0001).

Conclusions: During the past decade, life-threatening hemoptysis has remained an important problem. Flexible bronchoscopy and interventional angiography have become increasingly established, more widely accepted approaches to patient care.

Key Words: massive hemoptysis • respiratory emergencies




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