Fiberoptic bronchoscopy of intubated patients with life-threatening hemoptysis

Bleeding in the tracheobronchial tree in intubated patients on an intensive care unit is a potentially life-threatening incident. The antecedent state of disease and frequent respiratory failure require immediate and effectiv e therapeutic measures to avoid further respiratory and cardiocirculatory d epression. We present our bronchoscopic management of endobronchial bleedin g. Cardiorespiratory function must be maintained by modification of the mec hanical ventilation and drug therapy owing to the patient's condition. Seve n consecutive patients with acute endobronchial bleeding were treated with fiberoptic bronchoscopy and instillation of cold epinephrine-saline solutio n (1:10,000-100,000) during the period of July 1997 to December 1997. Contr ol of bleeding was achieved after 1 to 20 (mean +/- SEM: 5.86 +/- 0.93) bro nchoscopic interventions during a period of 0.5 hours to 10 days. One contr ol bronchoscopy was performed additionally in every patient. Cardiocirculat ory instability was observed in five patients. Six patients survived; one p atient died of uncontrolled bleeding caused by severe pulmonary aspergillos is. Fiberoptic endobronchial epinephrine instillation is an effective thera py for life-threatening hemoptysis in critically ill patients. Widespread u se of flexible bronchoscopy makes this procedure immediately applicable in critical situations. Intubated and mechanically ventilated patients,vith li fe-threatening hemoptysis especially benefit from this rapidly feasible pro cedure.