Management of acute pulmonary hemorrhage in children

Objective: Acute pulmonary hemorrhage can result from a variety of causes. This report offers a diagnosis and treatment plan for children with acute, life-threatening pulmonary hemorrhage resulting hom a variety of causes. Me thods: Retrospective review of children with acute pulmonary hemorrhage car ed for at a tertiary care children's hospital during from January 1, 1993 t o September 1, 1999, Patients: Fourteen children were identified with life- threatening pulmonary hemorrhage during the study period. Interventions: Br onchoscopy was the keystone to diagnosis of pulmonary hem orrhage in this s eries. All of the children underwent multiple procedures to stabilize the a irway and control blood loss. These interventions included CO2 laser bronch oscopy, Nd-YAG laser bronchoscopy, endoscopic balloon occlusion of a lobe o r main bronchus, topical airway vasoconstrictors, endoscopic tumor excision , transcatheter embolization of bronchial vessels, and lobectomy, Outcomes: Three children died and 11 survived without neurological sequelae, Conclus ions: Control of acute pulmonary hemorrhage is a difficult problem and ofte n requires multiple procedures. Endoscopic control is usually required for palliation until more definitive therapy can be undertaken.