Julien Dessajan, Aude Gibelin, Matthias Barral, Nina de Montmollin, Vincent Labbé, Michel Djibré, Guillaume Voiriot, Matthieu Turpin, Antoine Parrot, Muriel Fartoukh
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Lung cancer was the leading cause of SH, followed by bronchiectasis, tuberculosis, pneumonia, and aspergillosis. Compared with the historical cohort, pneumonia-related hemoptysis increased (11% vs. 5%; P < 0·001), as did pulmonary arterial involvement (12% vs. 5%; P < 0·001), mainly associated with pneumonia (23%), cancer, or aspergillosis (each 20%). Vascular interventional radiology (VIR) was first attempted in 81% of cases, achieving bleeding control in more than 90% of cases. Major adverse events occurred in 4.4% of cases. Emergent surgical lung resection (within 72 h) was performed in 2% of cases, all after VIR. In-hospital mortality rate increased slightly (8.7% vs. 6.5%; P = 0.08).</p><p><strong>Conclusions: </strong>Over the past decade, lung cancer became the leading cause of SH, with pneumonia increasingly contributing to pulmonary arterial involvement, reinforcing the need for multi-detector computed tomography angiography (MDCTA) screening. 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引用次数: 0
摘要
背景:重症监护病房(ICU)重症咯血(SH)的数据仍然很少。我们的目的是描述其临床特征、病因、管理策略和结果。这项回顾性观察性研究分析了2009年至2019年间转诊中心收治的SH患者。使用Cochran-Armitage检验将数据与历史队列(1995-2009)进行比较。结果:共分析945例患者(75%为男性,中位年龄55岁[IQR 42-65]);67%有呼吸道合并症。13%的患者在ICU入院24 h内需要有创机械通气。肺癌是SH的主要病因,其次是支气管扩张、肺结核、肺炎和曲霉病。与历史队列相比,肺炎相关咯血增加(11% vs. 5%); P结论:在过去十年中,肺癌成为SH的主要原因,肺炎越来越多地导致肺动脉受累,加强了对多探测器计算机断层扫描血管造影(MDCTA)筛查的需求。VIR的高成功率证实了其关键作用,而手术仍然局限于罕见病例。由于肺癌比例上升,住院死亡率略有上升。
Severe hemoptysis: etiologies, management, and outcomes from a single-center experience over the last decade.
Background: Data on severe hemoptysis (SH) in the intensive care unit (ICU) remain scarce. We aimed to describe its clinical characteristics, etiologies, management strategies, and outcomes. This retrospective observational study analyzed patients admitted for SH to a referral center between 2009 and 2019. Data were compared to a historical cohort (1995-2009) using the Cochran-Armitage test.
Results: A total of 945 patients (75% males; median age 55 years [IQR 42-65]) were analyzed; 67% had respiratory comorbidities. Invasive mechanical ventilation was required in 13% within 24 h of ICU admission. Lung cancer was the leading cause of SH, followed by bronchiectasis, tuberculosis, pneumonia, and aspergillosis. Compared with the historical cohort, pneumonia-related hemoptysis increased (11% vs. 5%; P < 0·001), as did pulmonary arterial involvement (12% vs. 5%; P < 0·001), mainly associated with pneumonia (23%), cancer, or aspergillosis (each 20%). Vascular interventional radiology (VIR) was first attempted in 81% of cases, achieving bleeding control in more than 90% of cases. Major adverse events occurred in 4.4% of cases. Emergent surgical lung resection (within 72 h) was performed in 2% of cases, all after VIR. In-hospital mortality rate increased slightly (8.7% vs. 6.5%; P = 0.08).
Conclusions: Over the past decade, lung cancer became the leading cause of SH, with pneumonia increasingly contributing to pulmonary arterial involvement, reinforcing the need for multi-detector computed tomography angiography (MDCTA) screening. The high success rate of VIR confirms its key role, while surgery remains limited to rare cases. In-hospital mortality slightly increased, driven by a higher proportion of lung cancer.
期刊介绍:
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.