Managing life-threatening hemoptysis: has anything really changed?

Chest. 2000 Nov;118(5):1431-5. doi: 10.1378/chest.118.5.1431.


Study objectives: To delineate current chest clinicians' approaches to the management of patients with life-threatening hemoptysis.

Design: Survey during a computer-assisted interactive continuing medical education presentation.

Setting: The 1998 American College of Chest Physicians (ACCP) Annual Scientific Assembly.

Participants: Chest clinicians attending the respiratory emergency symposium.

Results: Most clinicians (86%) had cared for patients with life-threatening hemoptysis, and 28% had cared for patients with fatal events during the previous year. Those clinicians favored management in the ICU setting (95%) with early endotracheal intubation (85%), and they tended to use a large-bore, single-lumen endotracheal tube (57%). The majority (64%) favored the early performance of diagnostic bronchoscopy during the first 24 h. Most clinicians (79%) used the flexible instrument, a higher frequency than respondents at a similar symposium on hemoptysis at the 1988 ACCP meeting (48%; p < 0.0001). Most current clinicians (77%) had experience with endobronchial measures to control bleeding, but few (14%) found them to be consistently worthwhile. Chest CT scanning was often helpful in diagnosis (55%). In their management of bleeding, half of these clinicians favored the use of interventional angiography, even in operable patients, which is a substantial change from 1988 when 23% had favored this approach (p < 0.0001).

Conclusions: During the past decade, life-threatening hemoptysis has remained an important problem. Flexible bronchoscopy and interventional angiography have become increasingly established, more widely accepted approaches to patient care.

MeSH terms

  • Angiography
  • Attitude of Health Personnel
  • Bronchoscopes
  • Bronchoscopy
  • Critical Care
  • Emergencies
  • Equipment Design
  • Hemoptysis / diagnostic imaging
  • Hemoptysis / prevention & control
  • Hemoptysis / therapy*
  • Humans
  • Intubation, Intratracheal / instrumentation
  • Pulmonary Medicine
  • Radiography, Interventional
  • Tomography, X-Ray Computed