ABSTRACT
BACKGROUND: The severity of hemoptysis is usually assessed on the amount of blood expectorated, although no threshold has been agreed upon. Respiratory or hemodynamic failures are additional severity criteria but occur in few cases. OBJECTIVES: Early identification of the in-hospital mortality determinants might be helpful to best characterize severe hemoptysis. METHODS: This is a retrospective cohort study of consecutive patients with hemoptysis admitted to the ICU of a teaching hospital during a 14-year period. The model for early prediction of in-hospital mortality was developed on a derivation sample (67% of patients) using multiple logistic regression. Calibration and discrimination of the model were tested using the remaining validation sample. A scoring system was developed for clinical use. RESULTS: The in-hospital mortality of the 1,087 patients (age 54 years, 71% male) was 6.5% (95% CI 5-8). Chronic alcoholism, cancer or aspergillosis, pulmonary artery involvement, infiltrates involving two quadrants or more on the admission radiograph, and mechanical ventilation at referral predicted independently mortality. The model showed good concordance between predicted and observed probabilities of death and good discrimination (receiver operating characteristic curve area 0.87; 95% CI 0.82-0.92). The model-based score (chronic alcoholism, pulmonary artery involvement, and radiographic patterns, 1 point each; cancer, aspergillosis, and mechanical ventilation, 2 points each) predicted the probability of death as follows: score 0, 1%; score 1, 2%; score 2, 6%; score 3, 16%; score 4, 34%; score 5, 58%; score 6, 79%, and score 7, 91%. CONCLUSIONS: Our results provide useful information about the short-term prognosis of patients with hemoptysis, which could help design therapeutic approaches and management plans according to the risk of in-hospital mortality.
Subject(s)
Hemoptysis/mortality , Hospital Mortality , Severity of Illness Index , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Hemoptysis/classification , Hemoptysis/complications , Hemoptysis/diagnosis , Humans , Intensive Care Units , Logistic Models , Male , Middle Aged , Prognosis , Retrospective Studies , Risk FactorsSubject(s)
Humans , Male , Middle Aged , Granular Cell Tumor , Granular Cell Tumor/surgery , Hemoptysis/complications , Hemoptysis/history , Hemoptysis/blood , Magnetic Resonance Imaging , /methods , Granular Cell Tumor/complications , Granular Cell Tumor/radiotherapy , Hemoptysis/classification , Hemoptysis , Neoplasms, Muscle Tissue/diagnosis , Neoplasms, Muscle Tissue/surgery , Neoplasms, Muscle Tissue , Granular Cell Tumor/physiopathologySubject(s)
Cystic Fibrosis/complications , Embolization, Therapeutic/methods , Hemoptysis , Adult , Bronchial Arteries/abnormalities , Bronchial Arteries/diagnostic imaging , Child , Embolization, Therapeutic/adverse effects , Hemoptysis/classification , Hemoptysis/physiopathology , Hemoptysis/therapy , Humans , RadiographyABSTRACT
BACKGROUND: Mild haemoptysis can change into massive haemoptysis and unfortunately one cannot predict whether it will change or not. For this reason, we investigated the records of patients who had been admitted due to haemoptysis retrospectively in order to find the trigger mechanisms of haemoptysis and the effects of conservative and aggressive treatment methods. METHODS: Hospital records of 249 patients with haemoptysis between 1997 and June 2005 were analysed retrospectively. Patients were classified into three groups according to the amount of blood expectorated in 24 hours. Group 1 included cases that had haemoptysis of less than 200 ml/24 h ; group 2 consisted of massive haemoptysis which was defined as expectoration of blood of 200-400 ml/24 h, and group 3 comprised patients who had 400 ml/24 h or more of haemoptysis defined as life-threatening haemoptysis. RESULTS: There were 169 male and 80 female patients. Mean age was 43.9 (4-78) in male patients and 33.8 (7-82) in female patients. The most frequent cause of haemoptysis was lung cancer in groups 1 and 2, and hydatid disease in group 3. Furthermore, we found that at least one trigger mechanism beyond primary disease caused haemoptysis in all groups. CONCLUSIONS: Haemoptysis is a life-threatening symptom that can alert patients to see a physician. Mild to moderate haemoptysis may change into massive and life-threatening forms. Unfortunately it is not predictable whether it will change or not. We deduced that a treatment strategy has to be planned according to trigger mechanism in patients with haemoptysis and that surgery is a definitive solution in these patients.
Subject(s)
Hemoptysis/etiology , Lung Diseases/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Bronchiectasis/complications , Bronchiectasis/diagnosis , Bronchiectasis/surgery , Bronchoscopy , Carcinoma, Bronchogenic/complications , Carcinoma, Bronchogenic/diagnosis , Carcinoma, Bronchogenic/surgery , Child , Child, Preschool , Diagnosis, Differential , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary/diagnosis , Echinococcosis, Pulmonary/surgery , Embolization, Therapeutic , Female , Hemoptysis/classification , Hemoptysis/surgery , Humans , Lung Diseases/complications , Lung Diseases/diagnosis , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Lung Neoplasms/surgery , Male , Middle Aged , Pneumonectomy , Retrospective Studies , Tomography, X-Ray Computed , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/surgeryABSTRACT
Bronchiectasis, cancer and tuberculosis account for the majority of haemoptysis requiring intensive care unit admission. Bedside evaluation (volume and bronchoscopic active bleeding) is safe to screen patients for arteriography and bronchial artery embolisation (BAE). First-line interventional arteriography should be favour over surgery in patients with non traumatic life-threatening hemoptysis. Surgery must be reserved in cases of failure or recurrence of bleeding after BAE.
Subject(s)
Critical Care , Hemoptysis/therapy , Blood , Bronchoscopy , Embolization, Therapeutic , Hemoptysis/classification , Hemoptysis/etiology , Hemoptysis/surgery , Hospitals, University , Humans , Oxygen Inhalation Therapy , Paris , Tomography, X-Ray ComputedABSTRACT
La sanguijuela es un anélido de la clase hirudíneos. La infestación en el humano se produce tras ingerir agua de pantanos o estanques, donde habita el gusano. La mayor incidencia ocurre en Asia, África y algunos países del área mediterránea, entre los que se encuentra España. La sanguijuela puede fijarse en cualquier punto del tracto aerodigestivo superior, siendo muy raro la fijación en la glotis. Presentamos el caso del un paciente varón de 48 años que presentó un esputo hemoptoico tras beber agua de una fuente rural. La exploración reveló una sanguijuela adherida en la comisura anterior laríngea. El tratamiento requirió la extracción bajo anestesia general, usando laringoscopia directa en suspensión (AU)
Subject(s)
Male , Middle Aged , Humans , Leeches/parasitology , Voice Disorders/complications , Voice Disorders/diagnosis , Foreign Bodies/diagnosis , Laryngeal Diseases/complications , Laryngeal Diseases/diagnosis , Laryngeal Diseases/surgery , Hemoptysis/complications , Hemoptysis/diagnosis , Laryngoscopy/methods , Laryngoscopy , Thorax/pathology , Thorax , Hemoptysis/classification , Hemoptysis , Water Pollution/prevention & controlABSTRACT
Hemoptysis is a frightening symptom for patients and often is a manifestation of significant underlying disease. The chest radiograph, history and examination findings, comorbid illnesses, and demographic factors guide evaluation of patients with minor hemoptysis. Massive hemoptysis occurs in less than 5% of patients with hemoptysis and is almost always due to serious pulmonary or systemic illness. Massive hemoptysis is a life-threatening event that requires ICU admission and urgent bronchoscopic evaluation for lateralization or localization of the bleeding site. Management should be individualized and requires prompt consultation with appropriate cardiothoracic surgery, pulmonary medicine, anesthesia, and interventional radiology staff. The availability of endobronchial techniques and bronchial arterial embolization has enhanced our ability to control massive bleeding short-term and decreased the need for emergency surgical treatment. Massive hemoptysis may recur without warning. Prompt workup and treatment are required for all patients.
Subject(s)
Hemoptysis/diagnosis , Hemoptysis/therapy , Algorithms , Bronchoscopy , Causality , Decision Trees , Diagnosis, Differential , Embolization, Therapeutic , Hemoptysis/classification , Hemoptysis/etiology , Humans , Intubation, Intratracheal , Medical History Taking/methods , Physical Examination/methods , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To define symptoms and therapeutic requirements for patients with metastatic or locally recurrent lung cancer. METHODS AND MATERIALS: Data were collected from 69 consecutive patients with locally advanced lung cancer seen in consultation at a radiation oncology facility serving a community hospital in Virginia. The Lung Cancer Symptom Scale, a validated quality of life instrument, measured the incidence of symptoms in this group. RESULTS: Average survival for the entire group was 7 months. Fifty-seven patients received 81 courses of radiation therapy, 33 directed at thoracic disease and 48 delivered to sites of metastasis. Thirty-three percent of those who received radiation therapy required treatment to more than one anatomic site. Every patient was symptomatic at the time of consultation, with the number (p = 0.001) and severity (p = 0.001) of symptoms they suffered worse in the patient group seen 0 to 3 months prior to death rather than 4 to 6 months prior to death. With the exception of cough, symptoms were marked in their severity. CONCLUSIONS: Patients with advanced lung cancer suffer frequent and severe symptoms that worsen in the final months of life. The appropriate timing and combination of radiotherapy and chemotherapy are yet to be resolved. Future studies will require use of validated quality of life instruments to better catalogue palliation and treatment toxicity.
Subject(s)
Anorexia/classification , Anorexia/etiology , Bone Neoplasms/complications , Bone Neoplasms/secondary , Brain Neoplasms/complications , Brain Neoplasms/secondary , Chest Pain/classification , Chest Pain/etiology , Cough/classification , Cough/etiology , Dyspnea/classification , Dyspnea/etiology , Fatigue/classification , Fatigue/etiology , Hemoptysis/classification , Hemoptysis/etiology , Lung Neoplasms/pathology , Neoplasm Recurrence, Local/complications , Quality of Life , Severity of Illness Index , Aged , Anorexia/psychology , Bone Neoplasms/mortality , Bone Neoplasms/therapy , Brain Neoplasms/mortality , Brain Neoplasms/therapy , Chest Pain/psychology , Combined Modality Therapy , Cough/psychology , Cross-Sectional Studies , Dyspnea/psychology , Fatigue/psychology , Female , Hemoptysis/psychology , Hospitals, Community , Humans , Incidence , Male , Palliative Care/methods , Prospective Studies , Survival Analysis , Time Factors , Treatment Outcome , Virginia/epidemiologySubject(s)
Hemoptysis/diagnosis , Hemoptysis/etiology , Bronchial Neoplasms/complications , Bronchitis/complications , Diagnosis, Differential , Hemoptysis/classification , Hemoptysis/physiopathology , Humans , Lung Neoplasms/complications , Pulmonary Circulation , Risk Factors , Severity of Illness Index , Tuberculosis, Pulmonary/complicationsABSTRACT
BACKGROUND: Hemoptysis is uncommon in pediatric practice. We reviewed 10 years of experience with hemoptysis in a tertiary pediatric hospital to identify patient characteristics and predictors of mortality. METHODS: Patients were divided into four age groups (0 to 5, 6 to 10, 11 to 20, and >20 years). Hemoptysis was defined as mild (<150 mL/day), large (150 to 400 mL/day), or massive (>400 mL/day). Fever was defined as >/=38.5 degrees C. RESULTS: A total of 228 patients (115 males and 113 females) with 246 episodes of hemoptysis were identified and grouped according to primary diagnosis. There were 149 patients in the cystic fibrosis (CF) group, 37 in the congenital heart disease (CHD) group, and 42 in the Other group. Age was significantly higher in the CF group compared with the CHD and Other groups. Length of stay was significantly prolonged in the CF group compared with the Other group. The overall mortality was 13%. After initial analysis, mortality predictors were age, amount of hemoptysis, receipt of blood products, and fever. After stratification, we found: 1) in the >20-year age group, there was a difference in mortality when comparing CF patients with CHD patients; 2) for patients who received blood products, there were differences in mortality in patients with CF, CHD, and Other diagnoses; 3) for patients who received blood, there were differences in mortality only for the 0- to 5-year age group; and 4) the amount of hemoptysis was predictive for mortality only in CHD patients. CONCLUSIONS: Hemoptysis presented in young adult CF patients and in adolescent CHD patients. Young adult CF patients with hemoptysis had a higher risk of mortality compared with young adult CHD patients. The amount of hemoptysis predicted mortality only for CHD patients. Receiving blood products was predictive of mortality for all patients.
Subject(s)
Hemoptysis/mortality , Adolescent , Adult , Age Factors , Analysis of Variance , Blood Transfusion , Child , Child, Preschool , Cystic Fibrosis/complications , Female , Fever , Heart Defects, Congenital/complications , Hemoptysis/classification , Hemoptysis/etiology , Hemoptysis/therapy , Hospitals, Pediatric , Humans , Infant , Length of Stay , Male , Respiratory Tract Infections/complications , Retrospective Studies , Risk Factors , TexasABSTRACT
La presencia de sangre en el esputo (hemoptisis) siempre es motivo de preocupación tanto para el enfermo como para el médico, quien con base en la historia clínica, y las ayudas diagnósticas aclarará su causa e instaurará por consiguiente el tratamiento más conveniente. En esta guía se plantean las diversas causas etiológicas de una hemoptisis y los pasos metodológicos establecidos para su diagnóstico y tratamiento haciendo referencia a la tecnología actual.
Subject(s)
Humans , Hemoptysis/classification , Hemoptysis/diagnosis , Hemoptysis/etiology , Hemoptysis/therapyABSTRACT
La hemoptisis es un evento raro, pero si es masiva, amenaza la vida del paciente y la causa de murte usualmente es por aspiración de sangre. La identificación del cuadro y la clasificación inicial deben realizarse rápida y simultáneamente con las medidas tendientes a controlar el sangrado y a mantener la vía aérea permeable. Esto dependerá de la cantidad de sangre expectorada, de la patología de fondo, y de la oportunidad con que se inicien las medidas anteriores. Aunque la cirugía permanece como la terapéutica definitiva, las medidas conservadoras usualmente controlan el sangrado agudo y proporcionan tiempo para otras alternativas terapéuticas especialmente en pacientes que no son candidatos para cirugía. Con esta clasificación y plan de manejo, esperamos facilitar la toma de decisión de un Servicio de Urgencias
