Fiberoptic bronchoscopy of the intubated patient with life-threatening hemoptysis

Introduction

Bleeding into the tracheobronchial tree is a potentially fatal occurrence for intubated patients. The subsequent acute respiratory failure requires an effective therapy. Fiberoptic bronchoscopy represents an easy available technique for the diagnosis and treatment of this type of hemoptysis.

Methods

We show the bronchoscopic management of endobronchial bleeding in intubated patients at our ICU. During the period 7/97–112/97 seven consecutive patients with acute endobronchial bleeding were treated with fiberoptic bronchoscopy. All patients received an endobronchial instillation of epinephrine and physiological saline solution (1:10 000–100 000).

Results

Control of bleeding was achieved with 1 to 20 (m ± SEM:5.86 ± 0.93) bronchoscopic interventions. Hemostasis was accomplished in a period of 0.5 h and 10 days. Cardiocirculatory instability was observed in five patients. One patient died because of persistent bleeding caused by severe aspergillosis. Six patients survived without further interventions.

Conclusion

Endobronchial instillation of epinephrine and physiological saline solution represents an effective method in case of lifethreatening hemoptysis in intubated and mechanical ventilated patients.

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