Case of the Month #21 - pulmonary haemorrhage

Published 01/02/2022

What is the initial management of suspected pulmonary haemorrhage?

Management of haemopytysis and hypoxic respiratory failure should follow an A-E approach with airway protection, ventilation and circulatory support with ongoing resuscitation and reversal of coagulation abnormalities.

  • Secure airway if there is ongoing moderate to large volumes of haemoptysis with evidence of hypoxic respiratory failure to minimise aspiration.
  • A large Endotracheal Tube (size 8.0mm or above) should be used with regular suctioning to keep clear and prevent blockage from clots.
  • Double lumen tubes can be used to provide single lung ventilation and isolation of bleeding side however can be difficult to place and prone to blockage with large clots.  
  • For mild to moderate pulmonary haemorrhage: nebulised or intravenous tranexamic acid has been reported to decrease haemoptysis and can be used as a temporising treatment prior to definitive management4.
  • In life threatening massive haemorrhage ongoing volume resuscitation with blood products and vasopressor therapy will be required. Thoracic surgery opinion should be sought for rapid intervention with rigid bronchoscopy to tamponade bleeding sites or for definitive surgical management1.