The pulmonary physician in critical care • Illustrative case 7:: Assessment and management of massive haemoptysis

The unpredictable and potentially lethal course of massive haemoptysis requires prompt resuscitation, airway protection, and correction of coagulopathy. Early investigation with bronchoscopy is recommended for localisation and control of bleeding by the application of topical adrenaline, balloon tamponade, or selective lung intubation. There is increasing acceptance of bronchial artery embolisation as the treatment of choice for acute massive haemoptysis not controlled by conservative treatment, when a bronchial artery can be identified as the source of bleeding. Surgical resection remains the treatment of choice for particular conditions where the bleeding site is localised and the patient is fit for lung resection.