Management of massive haemoptysis

Abstract

Massive haemoptysis is defined as volume of more than 600 ml of expectorated blood in 24 hours or more than 150 ml in 1 hour. There are many causes of massive haemoptysis such as bronchiectasis, lung neoplasm, pulmonary infection including tuberculosis or vascular abnormalities. The most critical features that have implication in the clinical outcomes of massive haemoptysis include the volume and the rate of bleeding, haemodynamic stability, and the effects on gas exchange through the bronchial obstruction. In fact, it is the effect on the airway compromise, which can lead to asphyxiation, which is of more importance. In patients with limited cardiopulmonary reserve smaller amount of haemoptysis may be of life-threatening nature. There are three aspects of importance when managing patients with massive haemoptysis including airway stabilisation, haemodynamic support and rapid identification of the bleeding source, and subsequent control of the bleeding, and management of the underlying condition leading to the bleeding.