Girişimsel Bronkoskopinin Hemoptizi Yönetiminde Rolü

Öz

Giriş: Hemoptizi, solunum yollarından kan gelmesiyle karakterize edilen ve tecrübeli klinisyenler için bile yönetimi zor bir klinik durumdur. Bronkoskopi, hemoptizi yönetiminde önemli bir rol oynamaktadır. Ancak tanı ve tedavide yeterince kullanımının olmadığını görmekteyiz.Çalışmamızda hemoptizi tanısıyla takip ettiğimiz hastalarda bronkoskopi uygulamalarımız üzerinden hemoptizide bronkoskopinin yeri ve önemini araştırmayı amaçladık. Yöntem: File records and data of patients with haemoptysis who were admitted to the pulmonary diseases service and intensive care unit or followed up as outpatients and underwent bronchoscopy were retrospectively analysed.Bulgular: Hastaların %19’una bronkoskopide herhangi bir bulgu görülmemiş ve işlem yapılmamışken, %55 ine topical uygulamalar, %7’sine sadece termal uygulamalar ve %19’una hem termal hem endobronşiyal tedaviler(EBT) işlemleri yapılmıştır.Sonuç: Çalışmamızın, hemoptizili hastaların tanı ve tedavi süreçlerinde bronkoskopinin önemli bir rol oynadığını ve bu yönteminin gelecekte klinik katkılarının daha da artma potansiyeline sahip olduğunu ortaya koyarak mevcut literatüre katkı sağlayacağını düşünmekteyiz.

Anahtar Kelimeler

• Hemoptizi
• Bronkoskopi
• Tedavi

The Role of Interventional Bronchoscopy in the Management of Haemoptysis

Öz

Aim: Haemoptysis is a clinical condition characterised by blood in the airways and is difficult to manage even for experienced clinicians. Bronchoscopy is a crucial tool in the treatment and evaluation of haemoptysis. However, we see that it is not used sufficiently in diagnosis and treatment. Within the scope of our research, we aimed to investigate the place and importance of bronchoscopy in haemoptysis through our bronchoscopy applications in patients we follow with the diagnosis of haemoptysis. Material and Method: The files and data of patients who were admitted to the Pulmonary Diseases Department and Intensive Care Unit with the diagnosis of haemoptysis or who were followed up as outpatients and underwent bronchoscopy were retrospectively reviewed. Results: Bronchoscopy findings were normal in 18% of patients, endobronchial lesions (EBL) in 18%, external compression in 1%, mucosal-submucosal infiltration, increased raying in 4%, narrowing of orifices in 2%, mucosal petechiae-vascularity increased in 2%, fragile mucosal hyperaemia-oedema in 12%, active haemorrhage in 5%, haemoptysis residues-coagulum in 37%, and purulent secretion in 1%. While no findings were observed in 19% of the patients during bronchoscopy and no procedure was performed, 55% received topical applications, 7% received only thermal applications, and 19% received both thermal and endobronchial treatments (EBT). Conclusion: We believe that our study will support the existing literature by revealing that bronchoscopy plays an important role in the diagnosis and treatment processes of patients with haemoptysis and that this method has the potential to increase its clinical contributions in the future.

Anahtar Kelimeler

• Hemoptysis
• Bronchoscopy
• Treatment

Kaynakça

1. O’Gurek D, Choi HYJ. Hemoptysis: Evaluation and Management. Am Fam Physician. 2022;105(2):144- 151.
2. Marquis KM, Ketai L, McAdams HP, et al. CT for Evaluation of Hemoptysis. Radiographics. 2021;41(3):742-761.
3. Earwood JS, Thompson TD. Hemoptysis: Evaluation and Management. Am Fam Physician. 2015;91(4):243-249.
4. Charya AV, Holden VK, Pickering EM. Management of life-threatening hemoptysis in the ICU. J Thorac Dis. 2021;13(8):5139.
5. Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest. 2020;157(1):77-88.
6. Corey R, Hla KM. Major and Massive Hemoptysis: Reassessment of Conservative Management. Am J Med Sci. 1987;294(5):301-309.
7. Abdulmalak C, Cottenet J, Beltramo G, et al. Haemoptysis in adults: A 5-year study using the French nationwide hospital administrative database. Eur Respir J. 2015;46(2):503-511.
8. Criner GJ, Eberhardt R, Fernandez-Bussy S, et al. Interventional bronchoscopy. Am J Respir Crit Care Med. 2020;202(1):29-50.

9. Ittrich H, Bockhorn M, Klose H, Simon M. Th Diagnosis and Treatment of Hemoptysis. Dtsch Arztebl Int. 2017;114(21):371.
10. Ryu C, Boffa D, Bramley K, Pisani M, Puchalski J. A novel endobronchial approach to massive hemoptysis complicating silicone Y-stent placement for tracheobronchomalacia. Medicine (Baltimore). 2018;97(8):e9980.
11. Tom LM, Palevsky HI, Holsclaw DS, et al. Recurrent Bleeding, Survival, and Longitudinal Pulmonary. Function following Bronchial Artery Embolization for Hemoptysis in a U.S. Adult Population. J Vasc Interv Radiol. 2015;26(12):1806-1813.e1.
12. Shao HX, Wu JP, Wu Q, et al. Bronchial artery embolization for hemoptysis: A retrospective observational study of 344 patients. Chin Med J (Engl). 2015;128(1):58-62.
13. Bhalla A, Kandasamy D, Veedu P, Mohan A, Gamanagatti S. A Retrospective Analysis of 334 Cases of Hemoptysis Treated by Bronchial Artery Embolization. Oman Med J. 2015;30(2):119.
14. Mondoni M, Baccelli A, Wahidi MM, et al. Effectiveness and Safety of Argon Plasma Coagulation in Patients with Haemoptysis Caused by an Endobronchial Malignancy. Respiration. 2024;103(9):563-571.
15. Valipour A, Kreuzer A, Koller H, Koessler W, Burghuber OC. Bronchoscopy-Guided Topical Hemostatic Tamponade Therapy for the Management of Life-Threatening Hemoptysis. Chest. 2005;127(6):2113-2118.
16. Gagnon S, Quigley N, Dutau H, Delage A, Fortin M. Approach to Hemoptysis in the Modern Era. Can Respir J. 2017;2017:1565030.
17. Talon A, Wang M, Saeed A. Bronchoscopic Management of Endobronchial Atypical Carcinoid With Argon Plasma Coagulation and Laser: A Rare Case With Literature Review. Cureus. 2021;13(3):e13862.
18. Ayers ML, Beamis JF. Rigid bronchoscopy in the twenty-first century. Clin Chest Med. 2001;22(2):355- 364.