Surgi̇cal treatment of li̇fe-threateni̇ng hemoptysi̇s: 15 years of experi̇ence

Hemoptysis is the name of the finding that the bleeding originating from any part of the respiratory system passing through the bronchial system and out through the mouth. While it can often disappear with medical treatment or spontaneously, the term “life-threatening hemoptysis” (LTH) has started to be used when it results in a serious event, such as airway obstruction, impaired gas exchange or hemodynamic instability. In this article, we aimed to share our surgical experiences with LTH, that has developed and changed in the literature in the past 15 years. In the same time we aimed to show the efficiency of surgery in LTH. This study includes a retrospective analysis of 129 patients who applied to our clinic with the complaint of hemoptysis, between 2005 and 2020. We included all patients who applied to our outpatient clinic with hemoptysis complaints and for whom we could access retrospective file information. We considered our patients with sudden onset or airway obstruction, deterioration in oxygenation and hemoptysis of 100 cc or more in 24 hours as life-threatening hemoptysis (LTH), and our other patients as minor hemoptysis. 74 (57.36%) of the patients were female and 55 (42.74%) were male. Those with LTH were 39% (30.23), and those without LTH were 9 (69.77%). Bronchiectasis seen in 35 patients (27.1%) was found to be the most common etiological disease. Lung cancer (26 cases, 20.15%) and tuberculosis (16 cases, 12.4%) were other common etiologies. The approach to hemoptysis should be made by considering every patient to return to the LTH form and should be treated by rapid diagnosis and treatment, with correct history and physical examination methods. Correct treatment, surgical timing in particular, can be lifesaving.

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1. Himanshu Deshwal, Ankur Sinha, Atul C. Mehta, Life-Threatening Hemoptysis. Semin Respir Crit Care Med. 2021;42: 45-159.

2. Bidwell JL, Pachner RW. Hemoptysis: diagnosis and management. American family physician. 2005;72:1253-60.

3. Larici AR, Franchi P, Occhipinti M, et al. Diagnosis and management of hemoptysis. Diagn Interv Radiol. 2014;20:299.

4. Harald I, Maximilian B, Hans K, et al. The diagnosis and treatment of hemoptysis. Dtsch Arztebl Int. 2017 114:371–81.

5. Norihisa S, Innes Y.W, Simon C.H.Y, et.al. Multidisciplinary management of life-threatening massive hemoptysis: A 10-year experience. Ann Thorac Surg. 2009;87:849-53.

6. Muriel F, Babak K, Antoine P, et.al. Early prediction of in-hospital mortality of patients with hemoptysis: An approach to defining severe hemoptysis. Respiration. 2012;83:106–14.

7. Kevin D, Samira S. Managing massive hemoptysis. Chest. 2020;157:77-8. 8. Hasmeena K, Helen M. H, Rajendran V, et al. Management of lifethreatening hemoptysis. J Intensive Care. 2020;8:1-9.

9. Ashish B, Ashok KP, Vikas S. Etiology and outcome of moderate-tomassive hemoptysis: Experience from a tertiary care center of North India. Int J Mycobacteriol. 2017;6:307-10.

10. Davidson K, Shojaee S. Managing massive hemoptysis. Chest. 2020;1:77- 88.

11. O'Donnell AE. Bronchiectasis. Chest. 2008;134:815-23.

12. Kinley D, Keerati H, Warissara J, et al. Bronchial artery embolization in life-threatening hemoptysis: Outcome and predictive factors. J Belg Soc Radiol. 2021;105:5.

13. F.Soares Pires,N.Teixeira,F.Coelho,C.Damas. Hemoptysis – etiology, evaluation and treatment in a university hospital. Revista Portuguesa de Pneumologia (English Edition). 2011;17:7-14.

14. John SE, Timothy DT. Hemoptysis: Evaluation and Management. Amecican Family Physician. 2015;91(4):243-249.

15. Jacob LB, Robert WP. Hemoptysis: Diagnosis and management. Amecican Family Physician. 2005;72:1253-60.

16. Emanuela B, Carlo G, Marco G, et.al. Palliative treatment of life-threatening hemoptysis with silicone stent insertion in advanced lung cancer. MMonaldi Arch Chest Dis. 2017;87:781.

17. Schaal JV, Tourtier JP, Auroy Y. Double-lumen endobronchial tube and alternatives in massive hemoptysis: How do you want to save lives? J Emerg Trauma Shock. 2011;4:438.

18. Oren F, Sonia S, Victoria R. Bronchial artery embolization for massive hemoptysis: Long-term follow-up. Asian Cardiovasc Thorac Ann. 2014; 23:55–60.

19. Sungmin W, Chang JY, Jin WC, et.al. Bronchial artery embolization to control hemoptysis: Comparison of N-Butyl-2-Cyanoacrylate and Polyvinyl alcohol particles. Radiology. 2013;269:594-602.

20. Ignasi GO, Jose SS, Carmen C, et.al. Results of bronchial artery embolization for the treatment of hemoptysis caused by neoplasm. J Vasc Interv Radiol. 2014;25:221-8.

21. Ong T-H, Eng P. Massive hemoptysis requiring intensive care. Intensive Care Med. 2003;29:317-20

22 Andréjak C, Parrot A, Bazelly B, et a l. Surgical lung resection for severe hemoptysis. Ann Thorac Surg. 2009;88:1556-65.

23. Valipour A, Kreuzer A, Koller H, et al. Bronchoscopy-guided topical hemostatic tamponade therapy for the management of life-threatening hemoptysis. Chest. 2005;127:2113-8.

24. Steinfort DP, Herth FJ, Eberhardt R, et al. Potentially fatal arrhythmia complicating endobronchial epinephrine for control of iatrogenic bleeding. Am J Respir Crit Care Med. 2012;185:1028-30.

25. Muriel F, Babak K, Antonie P, et.al. Early prediction of in-hospital mortality of patients with hemoptysis: An approach to defining severe hemoptysis. Respiration. 2012;83:106–14.

26. Crocco JA, Rooney JJ, Fankushen DS, et al. Massive hemoptysis. Arch Intern Med. 1968;121:495-8.

27. Garzon AA, Cerruti MM, Golding ME. Exsanguinating hemoptysis. J Thorac Cardiovasc Surg. 1982;84:829-33.