ICU · Respiratory

Massive haemoptysis in ICU

Also known as Massive haemoptysis · Life-threatening haemoptysis · Pulmonary haemorrhage · Bronchial artery embolisation

Massive haemoptysis: commonly defined as a blood loss of 600 mL/24 h or at a rate that poses a threat to life; trials operationalise massive as over 200 mL/24 h with haemodynamic or respiratory instability, and any amount causing airway compromise counts. True emergency — death from ASPHYXIATION (not exsanguination), sometimes within minutes. Causes: unknown in about half of cases; infectious/inflammatory airway diseases (incl. bronchiectasis) 25.8%, cancer 17.4%, TB (active and old cavities with mycetoma), pneumonia, vasculitis, AVM, trauma, iatrogenic. About 90% of bleeding arises from the BRONCHIAL (systemic) circulation. Management: (1) Protect airway — position bleeding side DOWN. (2) Oxygenate; intubate if necessary (large single-lumen ETT, double-lumen tube or blocker for lung isolation). (3) Bronchoscopy (rigid preferred for brisk bleeding; wedging, cold saline lavage, regional vasoconstrictors, balloon tamponade). (4) Bronchial artery embolisation (BAE) — first-line definitive, successful haemostasis in 75-98%; recurrence 13.9% at 12 months. (5) Surgery when BAE fails or for special indications (traumatic or iatrogenic pulmonary/vascular injury, refractory aspergilloma).

Checked against its sources on 14 Oct 2026