ICU · Respiratory / airway emergencies

Acute Massive Haemoptysis — Comprehensive ICU Management

Also known as Massive haemoptysis · Life-threatening haemoptysis · Massive hemoptysis · Pulmonary haemorrhage · Bronchial artery embolisation · Rigid bronchoscopy haemostasis · Ice-cold saline lavage · Double-lumen tube lung isolation · Rasmussen aneurysm · Aspergilloma haemoptysis

Acute massive haemoptysis is a respiratory emergency in which the patient dies of ASPHYXIATION, not exsanguination — a small volume of blood can rapidly flood the airways, abolish gas exchange, and cause hypoxaemic arrest long before the circulating volume is lost. Define it functionally as any bleeding that causes significant haemodynamic decompensation or respiratory distress that may lead to death if left untreated; volume-based definitions vary widely (anywhere from 100 to 1,000 mL per 24 hours has been considered significant, and fewer than 5 to 15 per cent of haemoptysis episodes are massive). Around 90 per cent of brisk bleeding arises from the BRONCHIAL (systemic, high-pressure) circulation and under 10 per cent from the pulmonary artery. Management is a fixed cascade: (1) protect the airway, isolate the non-bleeding lung, and keep the patient bleeding-side-down; (2) intubate with a large-bore single-lumen tube that admits a bronchoscope, or a double-lumen tube/bronchial blocker; (3) bronchoscopy — rigid preferred for massive bleeding — for cold saline lavage, topical vasoconstriction, and balloon tamponade; (4) bronchial artery embolisation (BAE), the first-line endovascular therapy, with pooled clinical success around 93 per cent (65-92 per cent depending on cause) and recurrence in roughly a quarter; (5) surgery for failure, unavailability, or localised lesions. Mortality across series is 9-38 per cent. This topic maps the cascade and the evidence behind every step.

Checked against its sources on 14 Oct 2026