ABSTRACT
Objective:Based on the business reengineering theory, to construct the emergency nursing process of acute massive hemoptysis in hospital and explore the effect of it.Methods:According to the order of hospitalization, 200 patients with acute massive hemoptysis admitted to the emergency department in Shanghai Pulmonary Hospital Affilated to Tongji University from January to June in 2020 were selected as the control group, and the original treatment process was adopted. Two hundred patients admitted to the emergency department of this hospital from July to December in 2020 were selected as the experimental group, and the reconstructed in-hospital emergency nursing process for acute massive hemoptysis was applied. In both groups, the researchers recorded the time spent in each sub-process by using the in-hospital treatment time record of acute massive hemoptysis and collected the clinical outcomes of patients through electronic cases. The time-consuming, treatment efficiency and patient outcome of each link of the treatment process in the backyard of the two groups were compared.Results:Finally, 192 patients were enrolled in the control group and the experimental group. The median time from admission to intravenous use of hemostatic drugs and from admission to endovascular treatment in the experimental group were 21.50(20.00, 22.50) and 82.50(79.50, 84.50) min, which were lower than those in the control group which spent 40.87(37.06, 44.43) and 135.50(123.50, 147.00) min, and the differences between the two groups were statistically significant ( Z=-16.84, 16.63, both P<0.01). The incidence of asphyxia caused by acute massive hemoptysis in the experimental group was 4.2%(8/192), which was lower than that in the control group, which was 13.0%(25/192) . There was a statistically significant difference in the incidence of asphyxia between the two groups( χ2=9.58, P<0.01). Conclusions:The emergency nursing process of acute massive hemoptysis effectively shortens the time of in-hospital treatment of acute massive hemoptysis, further promotes the seamless connection of multiple links of in-hospital treatment of acute massive hemoptysis, and improves the overall efficiency of in-hospital treatment of patients with acute massive hemoptysis.
ABSTRACT
Objective To evaluate the cause and the treatment of the vagus nerve reflex in patients with hemoptysis during bron-chial artery embolization (BAE).Methods 1 12 patients with much hemoptysis were enrolled,9 of whom represented vagus nerve reflex in the process of interventional embolization.Results In 9 patients with mixed vagal reflex,5 occurred in the process of bron-chial artery embolization,1 in removing of sheath,1 in hemostasis by compression and 2 in returning to the ward.The intraoperative vagus reflex during BAE was related to over tension and unnormolized operation,and it improved by block of vagus nerve,raising blood pressure and fluid expansion without serious complications.Conclusion Vagus nerve reflex during BAE should be noticed, and early detection and timely intervention may improve its prognosis.
ABSTRACT
Introducción: relatar un caso de hemoptisis masiva en el transoperatorio de cirugía pulmonar para establecer el manejo de la hipoxia en ventilación unipulmonar y con esto evitar devastadoras consecuencias. Caso clínico: paciente masculino de 46 años de edad con antecedente de varios episodios de hemoptisis, se sometió a lobectomía superior izquierda, presentando episodio de hemoptisis masiva en el transoperatorio, se siguió algoritmo de hipoxia en ventilación unipulmonar; a pesar de ello mantiene hipoxia prolongada por lo que se presentan secuelas importante de encefalopatía hipoxia. Conclusión: todo anestesiólogo que realice cirugías de pulmón debe estar en la capacidad de dominar el manejo de cualquier evento de hipoxia en ventilación unipulmonar.
Introduction: to relate a clinical case in OR of a pulmonary surgery for review the management of hypoxia in unipulmonar ventilation and with this realize that we could have catastrophic consequences. Clinic case: male patient, 46 years of age with a history of several episodes of hemoptysis underwent left upper lobectomy, presenting episode of intraoperative massive hemoptysis. Algorithm of hypoxia in one lung ventilation was followed nevertheless maintains prolonged hypoxia with important consequences of hypoxic encephalopathy. Conclusion: every anesthesiologist that have in OR a pulmonary surgery must have the knowledge of hypoxia in unipulmonar ventilation management.
Subject(s)
Humans , Male , Middle Aged , Pneumonectomy , Tuberculosis, Pulmonary , Hypoxia, Brain , One-Lung Ventilation , Hemoptysis , Hypoxia , General Surgery , Anesthesiologists , LungABSTRACT
Hemoptysis,defined as the expectoration of blood or blood-tinged sputum from the lower respiratory tract has to be differentiated from hematemesis and other anatomic site of bleeding.In pediatric patients with hemoptysis,no definite classification correlating severity with blood loss exists.Thus,clinical judgment is the primary tool that clinicians have in assessing the severity of hemoptysis in children.Infection is one of the most common etiologies for hemoptysis in children; however,cystic fibrosis was the most common cause of pediatric hemoptysis in the European countries.Hemoptysis is not a common chief complaint in pediatric patients unless massive hemoptysis.The causes of massive hemoptysis in children are bronchial adenoma,bronchial foreign body and vascular abnormalities.Vascular abnormalities is rare cause of hemoptysis,but one of the common cause of massive hemoptysis,including pulmonary arteriovenous malformation,absent pulmonary valve,aberrant systemic artery supplying.As one of aberrant systemic artery supplying,bronchial artery-pulmonary artery malformation cause life-threatening hemoptysis.The aim of imaging evaluation is to identify the source of bleeding along with determination of the primary cause of hemoptysis.The initial management option for bronchial artery-pulmonary artery malformation is bronchial artery embolization.Surgery is alternative option.The patients with bronchial artery-pulmonary artery malformation usually have massive hemoptysis,which can quickly progress to acute respiratory distress and shock.Therefore these children require emergency procedures to stabilize.
ABSTRACT
Se presenta nuestra experiencia en el tratamiento de la hemoptisis con embolización bronquial en pacientes con bronquiectasias, desde el 2001 al 2008, en el Hospital Italiano de Buenos Aires. Veinte pacientes fueron tratados con este método: 12 mujeres y 8 hombres con una edad media de 51 años (15-83 años). Las causas de bronquiectasias fueron secundarias a infecciones inespecíficas en el 40%; otro 40% secuelas de tuberculosis y 20% por enfermedad fibroquística. La indicación de embolización fue hemoptisis mayor a 300 ml/24 hs o hemoptisis persistentes durante más de 3 días consecutivos con requerimiento de hospitalización. En el 85% de los casos se efectuó embolización bronquial y en el resto (15%) bronquial y mamaria. Este procedimiento fue bilateral en el 60% de los pacientes, 20% solo en el lado derecho y 20% del lado izquierdo. En 18 pacientes se logró oclusión vascular completa de todos los territorios pulmonares patológicos. Control agudo del sangrado fue obtenido en todos los pacientes (100%) y sólo dos presentaron nuevo sangrado a los 8 y 12 meses respectivamente. Como efecto colateral al tratamiento se observó dolor torácico leve y transitorio en dos pacientes. Concluimos que la embolización de las arterias bronquiales constituye un tratamiento adecuado y seguro para el control agudo de la hemoptisis en pacientes con bronquiectasias.
We present our experience on arterial embolization for the treatment of hemoptysis in patients with bronchiectasis between 2001 and 2008 at the Hospital Italiano in Buenos Aires. Twenty patients were treated with this method: 12 women and 8 men with a median age of 51 years (15-83 years). Bronchiectasis was secondary to bacterial infections in 40% and secondary to tuberculosis infection in 40% of the patients; 20% of the patients had cystic fibrosis. Embolization was prescribed when the hemoptysis was above 300 ml/24 hours or the hemoptysis was persistent for more than 3 consecutive days and the patients hospitalization was required. In 85% of the cases embolization was done only in bronchial arteries and in the remaining 15% in bronchial and mammary arteries. The procedure was bilateral in 60% of the patients, only on the right side in 20% and only on the left side in 20%. In 18 patients complete occlusion was achieved. Complete control of the bleeding was obtained in 100% of patients. Only two patients had a new bleeding, 8 and 12 months later respectively. The treatment side effects were slight and transitory thoracic pain in two patients. We concluded that the embolization of the bronchial arteries is a suitable and safe treatment to control hemoptysis in patients with bronchiectasis.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Middle Aged , Aged, 80 and over , Bronchiectasis , Hemoptysis/therapy , Bronchial Arteries/ultrastructure , Catheterization, Peripheral/methods , Embolization, Therapeutic/methodsABSTRACT
Massive haemoptysis can occur in lung abscess. Massive haemoptysis itself may be life threatening due to asphyxiation or respiratory failure secondary to acute large airway obstruction by blood clots. Prompt removal of the obstructing blood clots save life. We describe a case of lung abscess causing massive haemoptysis resulting in acute airway obstruction which required rigid bronchoscopy to remove the huge blood clot. (JUMMEC2010; 13(2): 107-110)
Subject(s)
BronchoscopyABSTRACT
Objective To discuss the clinical application of feeding-artery embolization in treating massive hemoptysis.Methods The feeding-artery angiography was performed in 72 patients with massive hemoptysis.Based on the angiographic findings polyvinyl alcohol(PVA)or spring coil were selected as the embolization materials.The therapeutic results were retrospectively analyzed. Results Hemoptysis was completely controned almost immediately after the embolization procedure in 46 cases,while it was obviously alleviated in 13 cases.In 11 cases the hemoptysis disappeared completely after 2-4 times of embolization treatment,and in 2 cases surgery had to be employed.Conclusion Embolization of feeding-artery with PVA particles or spring coils is an effective and safe treatment for massive hemoptysis.The key point for decreasing reoccurrence is to occlude all feeding.arteries as far as possible.
ABSTRACT
Dieulafoy's disease of the bronchus is rare but potentially life-threatening, and should be considered in patients with massive hemoptysis, especially from unknown etiology. We report a case of a patient with massive hemoptysis due to bronchial Dieulafoy's disease. He underwent bronchial artery embolization and surgical resection, and the post-operative specimen revealed dilated and tortuous arteries in the submucosa that presented as Dieulafoy's disease of the bronchus.
Subject(s)
Humans , Arteries , Bronchi , Bronchial Arteries , HemoptysisABSTRACT
We treated a rare case of TO that presented with recurrent massive hemoptysis that resulted in total obstruction of the bronchus intermedius by very large blood clots. Bronchoscopic intervention resulted in a full recovery from the atelectasis. However, there are no guidelines for preventing recurrence of the hemoptysis or disease progression. Conservative and expectant management are used to treat these patients and most do well.
Subject(s)
Humans , Bronchi , Disease Progression , Hemoptysis , Pulmonary Atelectasis , RecurrenceABSTRACT
Massive and untreated hemoptysis is associated with a >50% mortality rate. Since bleeding has a bronchial arterial origin in most patients, bronchial artery embolization (BAE) has become an accepted treatment in massive hemoptysis. The possibility of bleeding from pulmonary artery should be considered in patients in whom the bleeding focus cannot be found by Bronchial angiogram. Indeed, the bleeding occurs from a pulmonary artery in approximately 10% of patients with massive hemoptysis. The most common causes of bleeding from the pulmonary artery are pulmonary artery rupture associated with a Swan-Ganz catheter, infectious diseases and vasculitis. We report a rare case of a fistula between the right upper lobar pulmonary artery and the right upper lobar bronchus in a 71-year-old woman who presented with massive hemoptysis.
Subject(s)
Aged , Female , Humans , Bronchi , Bronchial Arteries , Catheters , Communicable Diseases , Fistula , Hemoptysis , Hemorrhage , Mortality , Pulmonary Artery , Rupture , Tuberculosis, Pulmonary , VasculitisABSTRACT
A 13-year-old girl was admitted with massive hemoptysis and hematemesis. An estimated volume was about 400 cc. The blood was frothy and mixed with sputum and food. She had no history of epistaxis, choking, joint pain or trauma. Her vital sign was stable and physical examination was normal except for bilateral crackles and ronchi on auscultation of the lungs. Laboratory data on arrival including blood counts, liver enzyme, urinalysis and electrolytes were all normal. Chest CT showed bilateral extensive centrilobular ground glass opacity nodules and there were suspicious blood clots in the right bronchus. There was no evidence of pleural effusion, increased vascular markings, abscess or brochiectasis. We performed an upper GI endoscopy and bronchoscopy, it was all normal. On cytology from bronchoalveolar lavage, cell count was 1,660/microL with 63% of macrophages laden with erythrocytes and 35% lymphocytes. Tuberculosis PCR from this fluid was negative and AFB stain, Gram stains were all negative. She has had a second attack on day seven, emergency bronchial angiography was performed. There was dysplastic bronchial artery with a tortuous change, shunting to the pulmonary artery. Bronchial artery embolization was performed successfully using embolization particles. Follow-up blood counts, electrolytes and chest radiogram were all normal. There was no further episode of hemoptysis twelve months after embolization.
Subject(s)
Adolescent , Child , Female , Humans , Abscess , Airway Obstruction , Angiography , Arthralgia , Auscultation , Bronchi , Bronchial Arteries , Bronchoalveolar Lavage , Bronchoscopy , Cell Count , Coloring Agents , Electrolytes , Emergencies , Endoscopy , Epistaxis , Erythrocytes , Follow-Up Studies , Glass , Hematemesis , Hemoptysis , Liver , Lung , Lymphocytes , Macrophages , Physical Examination , Pleural Effusion , Polymerase Chain Reaction , Pulmonary Artery , Respiratory Sounds , Sputum , Thorax , Tomography, X-Ray Computed , Tuberculosis , Urinalysis , Vital SignsABSTRACT
Se revisan 27 enfermos consecutivos ingresados a la Unidad de Neumologfa y Cirugía de Tórax "Alejandro Celis" del Hospital General de México, SSA, por hemoptisis durante 2005; 6 de ellos, con sangrado superior a 600 mL en 48 h [hemoptisis masiva (HM)]. La causa del sangrado fue tuberculosis pulmonar avanzada en 9, bronquiectasias, 4; tumores, 3; aspergilomas, 2; y bronquitis, neumonía y trauma 7 de cada 7. Se les practicó fibrobroncoscopía (FBC) a todos, embolización de arterias bronquiales a 5; resección pulmonar a 4 y taponamiento bronquial a 7. En los 6 con HM la FBC localizó el bronquio sangrante. Dos de los 6 enfermos con HM fallecieron por asfixia secundaria a inundación de vías aéreas; los otros 4 viven. El manejo del enfermo con sangrado respiratorio depende del volumen de sangre expectorada, la etiología y las condiciones del enfermo; las opciones terapéuticas varían desde el manejo conservador hasta la resección pulmonar. Los enfermos con HM se deben tratar en unidades especializadas en cuidados intensivos por neumólogos intensivistas certificados.
During 2005 we admitted 27 patients with hemoptysis, six of them with massive hemoptysis (more that 600 mL in 48 h). The cause of bleeding was pulmonary tuberculosis in nine, bronchiectasias in four, tumors in three, aspergillomas in two and one of each due to bronchitis, pneumoniae and thoracic trauma. All had fiberoptic bronchoscopy; five had bronchial artery embolization (BAE), four had pulmonary resection and one bronchial tamponade. Two with massive bleeding died due to asphyxia before BAE or surgery could be performed. The rest are alive and well. The management of hemoptysis depends on the amount of blood, the etiology and the conditions of the patient; therapeutic options available are medical treatment, tracheal intubation, interventional endoscopy, BAE and surgery. Patients with massive hemoptysis should be treated by board certified pulmonologists critical-care specialists.
ABSTRACT
Se presenta el caso de un paciente con hipertensión arterial sistémica, hemoptisis masiva y hemotórax izquierdo. La necropsia demostró la presencia de un aneurisma disecante del cayado de la aorta, abierto al parénquima del lóbulo superior del pulmón izquierdo y comunicación a la cavidad pleural, alteraciones que provocaron hemoptisis masiva y hemotórax en circunstancias poco frecuentes. La formación del aneurisma posiblemente estuvo relacionada con la hipertensión arterial preexistente. Se discuten aspectos relevantes en relación con la literatura consultada.
We present a 70 year old male with long standing systemic arterial hypertension that presented with massive hemoptysis and left hemothorax. Necropsy showed a dissecting aneurysm of the aortic arch rupturing into the upper lobe of the left lung and the left pleural cavity, an uncommon cause of massive hemoptysis and hemothorax. The etiology of the aneurysm and dissection were probably related to the systemic hypertension. Relevant facts regarding this pathology are discussed.
ABSTRACT
Hemoptysis, when massive and untreated, has a mortality rate of more than 50%. Therefore, significant hemoptysis calls for swift detection of the anatomic source of the hemorrhage so that definite therapy can be initiated to stop bleeding. Bronchoscopy, chest roengenography and CT scans may point to the likely source of the hemorrhage. Since the bronchial circulation is the major source of hemoptysis, therapeutic embolization of bronchial arteries can be performed to stop bleeding. Angiographic and clinical data from 30 patients (35 sessions) with hemoptysis who were referred for embolotherapy between 1998-2002 were retrospectively reviewed. The most frequent causes of hemoptysis were tuberculosis (66%), bronchiectasis (11%) and other various conditions resulting in bronchpulmonary anastomoses (11%). The bronchial embolization was attempted in 27/35 sessions with percentage grading successful rate of embolization. Recurrent hemoptysis could be as high as 100% if the initial embolization success rate was less than 50%. Overall, 14/27 patients suffered a bleeding relapse. Note that nine of these patients experienced a bleeding relapse within 30 days, whereas the rest occurred more than 30 days after embolization. Note that, repeat embolization can be performed safely.
ABSTRACT
A 43 years old woman with a previous history of healed tuberculosis presented with a recurrent hemoptysis. On a broncoscopy inspection, three nodular shaped mass-like lesions (0.5cm in diameter) were found on the right lower lobar bronchus. Massive hemoptysis occurred when the specimen were taken during bronchoscopy. The bleeding could not be controlled by non-surgical treatment. Consequently, she underwent a right lower lobectomy in order to control the bleeding. The patient died of respiratory failure 3 days later. A brochoscopic biopsy revealed an abnormal blood vessel just beneath the bronchial respiratory epithelium.
Subject(s)
Female , Humans , BiopsyABSTRACT
A 43 years old woman with a previous history of healed tuberculosis presented with a recurrent hemoptysis. On a broncoscopy inspection, three nodular shaped mass-like lesions (0.5cm in diameter) were found on the right lower lobar bronchus. Massive hemoptysis occurred when the specimen were taken during bronchoscopy. The bleeding could not be controlled by non-surgical treatment. Consequently, she underwent a right lower lobectomy in order to control the bleeding. The patient died of respiratory failure 3 days later. A brochoscopic biopsy revealed an abnormal blood vessel just beneath the bronchial respiratory epithelium.
Subject(s)
Female , Humans , BiopsyABSTRACT
A 42 year-old male with a history of multidrug-resistant pulmonary tuberculosis suddenly developed massive hemoptysis. Embolization of a bronchial artery branch and the collateral systemic arteries did not resolve the recurrent bleeding. Spiral computerized tomography(spiral CT) of the chest showed contrast enhanced nodules within a large cavity at the left lower lobe in the arterial phase suggesting a Rasmussen aneurysm. A pulmonary angiogram showed abnormal vascular nodules at that site. Coils were deployed at both the proximal and distal vessels of this aneurysmal sac for embolization. Transcatheter arterial embolization is a safe and effective means of controlling bleeding from this pulmonary arterial pseudoaneurysm. Here we report a case of a Rasmussen aneurysm diagnosed by spiral CT, which was successfully treated by pulmonary arterial embolization with a coil.
Subject(s)
Humans , Male , Aneurysm , Aneurysm, False , Arteries , Bronchial Arteries , Embolization, Therapeutic , Hemoptysis , Hemorrhage , Respiratory Insufficiency , Thorax , Tomography, Spiral Computed , Tuberculosis, PulmonaryABSTRACT
Objective:To observe the curative effect and complication of o number line segment embolization in bronchialartery and to study the safety and curative effect of bronchial artery embolization with o number line segment in the treatment for massive hempotysis.Methods:A total of 35 patients with massive hemoptysis(30 males,5 females) were performed selective bronchial artery embolization.All cases were embolized with o number line segments.All patients had been followed up for one to eighteen months,with the second embolization if relapsed.Results:Immediate and complete control was achieved in 34 cases(97.1%),relapse occurred in 4 cases(11.4%),and no patient had spinal cord injury.Conclusion:Bronchial artery embolization with 0 number line segment can significantly reduce the recurrence,and is the safe and effective treatment for hemoptysis.