RESUMO
Fundamento y objetivo: La hemoptisis amenazante (HA) es una emergencia médica cuya historia natural no está bien definida. El objetivo de este estudio fue evaluar la etiología, los procedimientos realizados y la evolución de la HA en un hospital universitario. Pacientes y método: Estudio prospectivo en el que se incluyeron en un protocolo 154 pacientes ingresados por HA durante 3 años consecutivos. Se realizaron técnicas broncoscópicas y angiográficas según criterio del médico que les atendía. Se siguió la evolución de los pacientes durante 5 años tras el episodio de HA. Resultados: Un 79,2% eran varones. La edad media (DE) fue de 57 (15) años. La etiología más frecuente fueron las bronquiectasias, la tuberculosis activa y sus secuelas. Un 4,5% de pacientes fallecieron a consecuencia de la HA. La broncoscopia se mostró más segura en la localización del sangrado que la arteriografía cuando las exploraciones se realizaban durante la hemoptisis (84,2 frente a 20,4%) (p<0,001). Cuando la embolización o la broncoscopia se utilizaron como primera medida, durante el ingreso la primera estabilizó el sangrado con mayor eficacia que la segunda (87 frente a 53,5%) (p<0,001). Se produjeron un 10,7% de recidivas de HA, menos frecuentemente cuando la embolización había sido efectuada. Conclusiones: Las bronquiectasias y la tuberculosis fueron las causas más frecuentes. Mientras la broncoscopia durante la hemoptisis se mostró eficiente en localizar el origen del sangrado, la embolización arterial fue más eficaz en su estabilización tanto a corto como a largo plazo (AU)
Background and objectives: The natural history of life-threatening hemoptysis (LTH), a medical emergency, is ill defined. The objective of the study was to evaluate, in a university teaching hospital setting, the etiology, methods used, and evolution of LTH. Patients and methods: Prospective study in which we enrolled 154 patients admitted for LTH over 3 consecutive years. Bronchoscopy and arteriography procedures were performed, as prescribed by the attending physician. Patient evolution was followed 5 years post-event. Result: 79.2% were male. Average age was 57 (SD 15) years. Bronchiectasis and active tuberculosis and its consequences were the predominant etiologies. A total of 4.5% patients died as a result of LTH. Bronchoscopy was more effective in identifying the bleeding than arteriography when the examination was performed during an episode of hemoptysis (84.2 versus 20.4%) (P<.001). When embolization or bronchoscopy were used as first measure, embolization was more effective in stabilizing bleeding than bronchoscopy (87 versus 53.5%) (P<.001) in admitted patients. LTH relapse was 10.7%, while it was lower with embolization. Conclusions: Leading causes were bronchiectasis and tuberculosis. While bronchoscopy during a hemoptysis episode was effective in identifying the source of the bleeding, artery embolization was more effective in stabilizing the patient both at the short and long term (AU)
Assuntos
Humanos , Hemoptise/epidemiologia , Hemorragia Bucal/epidemiologia , Embolização Terapêutica , Estudos Prospectivos , Broncoscopia , Angiografia , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricosRESUMO
BACKGROUND AND OBJECTIVES: The natural history of life-threatening hemoptysis (LTH), a medical emergency, is ill defined. The objective of the study was to evaluate, in a university teaching hospital setting, the etiology, methods used, and evolution of LTH. PATIENTS AND METHODS: Prospective study in which we enrolled 154 patients admitted for LTH over 3 consecutive years. Bronchoscopy and arteriography procedures were performed, as prescribed by the attending physician. Patient evolution was followed 5 years post-event. RESULT: 79.2% were male. Average age was 57 (SD 15) years. Bronchiectasis and active tuberculosis and its consequences were the predominant etiologies. A total of 4.5% patients died as a result of LTH. Bronchoscopy was more effective in identifying the bleeding than arteriography when the examination was performed during an episode of hemoptysis (84.2 versus 20.4%) (P<.001). When embolization or bronchoscopy were used as first measure, embolization was more effective in stabilizing bleeding than bronchoscopy (87 versus 53.5%) (P<.001) in admitted patients. LTH relapse was 10.7%, while it was lower with embolization. CONCLUSIONS: Leading causes were bronchiectasis and tuberculosis. While bronchoscopy during a hemoptysis episode was effective in identifying the source of the bleeding, artery embolization was more effective in stabilizing the patient both at the short and long term.
