Managing life-threatening hemoptysis - Has anything really changed?

Study objectives: To delineate current chest clinicians' approaches to the management of patients,vith life-threatening hemoptysis. Design: Survey during a computer-assisted interactive continuing medical ed ucation presentation. Setting: The 1998 American College of Chest Physicians (ACCP) Annual Scient ific Assembly. Participants: Chest clinicians attending the respiratory emergency symposiu m. Results: Most clinicians (86%) had cared for patients with life-threatening hemoptysis, and 28% had cared for patients with fatal events during the pr evious year. Those clinicians favored management in the ICU setting (95%) w ith early endotracheal intubation (85%), and they tended to use a large-bor e, single-lumen endotracheal tube (57%). The majority (64%) favored the ear ly performance of diagnostic bronchoscopy during the first 24 h, Most clini cians (79%) used the flexible instrument, a higher frequency than responden ts at a similar symposium on hemoptysis at the 1988 ACCP meeting (48%; p < 0.0001). Most current clinicians (77%) had experience with endobronchial me asures to control bleeding, but few (14%) found them to be consistently wor thwhile. Chest CT scanning was often helpful in diagnosis (55%), In their m anagement of bleeding, half of these clinicians favored the use of interven tional angiography, even in operable patients, which is a substantial chang e from 1988 when 23% had favored this approach (p < 0.0001). Conclusions: During the past decade, life-threatening hemoptysis has remain ed an important problem, Flexible bronchoscopy and interventional angiograp hy have become increasingly established,, more widely accepted approaches t o patient care.