General measures
- Monitor or ensure vital signs (respiratory and circulatory function; basic life support):
- Pulse oximetry – continuous noninvasive measurement of arterial blood oxygen saturation and pulse rate.
- Positioning the patient on the bleeding side – so that endobronchial blood cannot enter unaffected lung segments
- In case of massive hemoptysis: securing the airway by endotracheal (through a hollow plastic probe) if necessary unilateral endobronchial (“into the bronchus”) intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea)
- Oxygen administration – during spontaneous breathing: 8-10 liters/minute.
- Sedation/anxiolysis – sedation of the patient and facilitation of necessary diagnostic and therapeutic measuresNote: The measures must not lead to restriction of respiratory activity and exploration ability. Likewise, the ability to communicate must be ensured.
Conservative therapy/drug therapy
- In mild or moderate hemoptysis, treatment of the underlying disease (infection; coagulation disorder) by conservative therapy/drug therapy is usually promising.
Conventional non-surgical therapy methods
- Therapeutic bronchoscopy:
- The goal is to maintain or ensure gas exchange by freeing the airways of blood
- Hemostasis by local therapy of visible sources of bleeding.
- Bronchial artery embolization (BAE) – minimally invasive, endovascular therapeutic procedure to stop bleeding by lowering the systemic arterial perfusion pressure (pressure at which a tissue is perfused) in the bronchial arteries (arteries of the systemic circulation that serve to supply the bronchi and lung parenchyma) of the pathologically (pathologically) altered area.The success rate in terms of bleeding control is 75-98%.
Surgical therapy
Indications (areas of application)
- Bleeding due to
- Necrotizing tumor disease
- Tuberculous caverns or
- Therapy-resistant aspergillomas
- Unsuccessful bronchial artery embolization (BAE).
Surgical therapy consists of surgical resection (removal of tissue parts of an organ or even a tumor) and thus removal of the source of bleeding.
