Operative treatment of massive hemoptysis

Fifty-five pulmonary resections have been performed at our institution for hemoptysis of 600 ml. or more in 24 hours. The overall mortality was 18% as compared with more than 75% in patients who bled 600 ml. or more in 16 hours and 54% in patients who bled 600 ml. or more in 48 hours, all of whom were managed conservatively. Mortality correlated with the rate of bleeding irrespective of the extent of resection. Nineteen patients were bleeding massively at the time of pulmonary resection and required single lung ventilation; of these, 7 (37%) died. Of the 36 patients in whom active bleeding had ceased at the time of pulmonary resection, 3 (8%) died. In 2 patients with extensive bilateral disease, cavernostomy and packing of bleeding cavities was employed. The most common cause of death was respiratory insufficiency. Our experience indicates that operative treatment of massive hemoptysis offers a reduced mortality as compared with conservative management.