Abstract

Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.

Publication History

Publication Date:
30 August 2020 (online)

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

中文翻译：

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危及生命的咯血。

摘要

危及生命的咯血 (LTH) 是任何数量的咯血，会导致明显的血流动力学失代偿或呼吸窘迫，如果不及时治疗可能导致死亡。虽然大咯血的咯血量一直存在争议，但 100 至 1,000 毫升/天之间的任何量都被认为是显着的。高达 15% 的咯血病例是 LTH，需要紧急挽救生命的干预措施。了解肺血管解剖对于管理 LTH 至关重要。治疗的目标在于保护气道、适当的氧合和预防失血。一旦气道稳定，就可以快速诊断和控制出血部位。本章重点介绍 LTH 的当前实践和方法，包括医疗管理、支气管镜方法、以及支气管动脉栓塞和手术切除等先进疗法。我们以系统和循证的方式回顾了支气管扩张、血管畸形、弥漫性肺泡出血和气管切开术出血等情况，以及这些情况的具体管理方法。

出版历史

发布日期：
2020 年 8 月 30 日（在线）

© 2020。蒂姆。版权所有。

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA。