pituitrin and Hemoptysis

Airway hemorrhage is a potentially rapidly fatal condition. Death may occur within minutes from asphyxiation before control can be achieved. The primary prognostic factors are the rate of bleeding and the underlying cardiopulmonary status of the patient. Bronchoscopy is central in management, but the goals differ, depending on circumstances. In stable patients who have minimal hemoptysis, bronchoscopy can diagnose the cause specifically and be used as the primary treatment modality. In the setting of massive or life-threatening bleeding, bronchoscopy primarily is performed to maintain ventilation and to direct endobronchial blockade. Although flexible bronchoscopy is an acceptable mode initially, there should be no delay in performing rigid bronchoscopy when it becomes apparent that bleeding is too vigorous to permit [figure: see text] successful airway exploration with the smaller flexible instrument. Once isolation of bleeding has been achieved, the choice must be made between embolization, surgical resection, or both of these procedures.

Topics: Acute Disease; Bronchoscopy; Combined Modality Therapy; Embolization, Therapeutic; Epinephrine; Hemoptysis; Humans; Prognosis; Vasopressins

Hemoptysis is usually a symptom of cardiopulmonary disease and is generally not in itself associated with death. A blood loss into the tracheobronchial tree of 600 ml in 24 hours or at a rate that poses a threat to life is referred to as massive hemoptysis. Hypervascularity within the bronchial circulation, usually associated with diffuse inflammatory disease of the lung, is common in patients with massive hemoptysis. Management should be directed at maintenance of oxygenation and localization of the source of bleeding. Temporizing maneuvers such as iced saline lavage, intravenous administration of vasopressin, endobronchial tamponade and bronchial artery embolization will often stabilize the patient in preparation for definitive surgery. Such a sequential plan of management may result in a 50% reduction in the rate of death from massive hemoptysis, which is otherwise 50% to 100%.

Topics: Bronchoscopy; Embolization, Therapeutic; Hemoptysis; Hemostatic Techniques; Humans; Intubation, Intratracheal; Lung; Positive-Pressure Respiration; Vasopressins

Interventional radiology is defined as a radiologic subspecialty and the services provided are tabulated in this article; those services relevant to internists are described in greater detail. This article is intended as a survey, and the authors encourage the reader to consult the references provided for a more in-depth review.

Topics: Abscess; Angiography; Angioplasty, Balloon; Arterial Occlusive Diseases; Arteriovenous Malformations; Biopsy, Needle; Cholestasis; Drainage; Embolization, Therapeutic; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Hemoptysis; Humans; Neoplasms; Peptic Ulcer; Radiography; Vasopressins

Bleeding occurs with some regularity at the end of life. Patients often endure fatigue, weakness, pain, dyspnea and anxiety. These symptoms are magnified in visually apparent bleeds. Management can be particularly challenging as we attempt to balance therapies with goals of care. Children are at risk for such complications and symptoms; providers must ensure comfort for both the patient and family.. A 7-year-old male with recurrent, refractory Burkitt lymphoma was frequently hospitalized for palliative chemotherapy and disease complications. On his final admission, he experienced gross hemoptysis and hematemesis: he was short of breath, fatigued and anxious due to his blood loss. His and his family's angst were heightened by "seeing" his bleed. Potential, especially invasive, treatments were limited by our goals to promote comfort, limit interventions, maintain alertness, poor intravenous access and a small bowel obstruction. Nebulized vasopressin, 10 units in 4ml of normal saline given over 10 minutes provided JC with needed relief. His bleeding remitted and he tolerated its administration.. There are many treatments for hemorrhage; however, given the challenges of goals of care, administration, side-effects and tolerability, further investigation into nebulized vasopressin as a potential therapy for hemoptysis and hematemesis at the end-of-life is warranted.

Topics: Administration, Inhalation; Burkitt Lymphoma; Child; Fatal Outcome; Hematemesis; Hemoptysis; Humans; Male; Palliative Care; Vasoconstrictor Agents; Vasopressins

In pregnant women, the reported cases of hemoptysis were most often mild and had an identified cause. Between November 2003 and January 2006, three pregnant women at 16-20 weeks gestation were admitted to our respiratory intensive care unit for massive hemoptysis. One of the women had experienced mild hemoptysis, considered as idiopathic, during her first pregnancy, with no recurrence until her second pregnancy. In all three cases, hemoptysis was massive. CT scan after iodine injection did not reveal any cause. Opacification of the bronchial artery showed hyperemia from abnormally dilated and tortuous bronchial arteries. Bronchial artery embolization (BAE) was performed in all three patients, successfully in two. Intravenous vasopressin was used as second-line treatment for recurrent bleeding after BAE in one patient. The women carried the pregnancy to term with delivery of healthy infants. Further complete investigation after the births did not identify any possible local (pulmonary) or general cause of bleeding in these three patients. Although these cases could be considered idiopathic, the close association with duration of pregnancy suggests the hemoptysis may be related to hormonal changes.

Topics: Adult; Female; Hemoptysis; Humans; Male; Pregnancy; Pregnancy Complications; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

Topics: Aerosols; Hemoptysis; Hemostatics; Humans; Palliative Care; Vasopressins

Topics: Cystic Fibrosis; Hemoptysis; Humans; Vasopressins

Desmopressin and vasopressin were used to control massive haemoptysis in a patient with cystic fibrosis. After bolus doses a continuous infusion of vasopressin was maintained for 36 hours and haemoptysis stopped.

Topics: Adult; Cystic Fibrosis; Deamino Arginine Vasopressin; Drug Therapy, Combination; Hemoptysis; Humans; Male; Vasopressins

Topics: Aged; Female; Hemoptysis; Humans; Multiple Organ Failure; Necrosis; Skin; Tranexamic Acid; Vasopressins

Topics: Adult; Hemoptysis; Humans; Infusions, Parenteral; Male; Vasopressins

Topics: Blood Coagulation; Bronchiectasis; Bronchitis; Capillary Permeability; Diagnosis, Differential; Hemoptysis; Humans; Lung Neoplasms; Menstrual Hygiene Products; Pathology; Pharmacology; Pituitary Hormones, Posterior; Sympathomimetics; Tampons, Surgical; Tracheitis; Tuberculosis; Tuberculosis, Pulmonary; Vasopressins