Pulmonary hemorrhage is a very serious condition due to bleeding into the region of the bronchi. It requires emergency medical attention. Pulmonary hemorrhage is a dangerous complication of various respiratory, hematological and cardiological diseases. This pathology has a second name - diffuse alveolar hemorrhage syndrome. Bloody discharge from blood vessels is formed due to a violation of their integrity, and, in addition, due to the collapse of the lung tissue. Intense blood loss can dramatically worsen the well-being of the patient, disrupting the heart, respiratory tract, and, at the same time, blood forming organs.
Basic disease information
Pulmonary hemorrhage, which is caused by traumatic injury or the action of chemical components, is an independent disease. In this case, the danger to the patient’s body is determined by the degree of damage, and, in addition, by its intensity. Hemoptysis, as a rule, does not threaten life and is considered not so dangerous to health. It appears when the tracheobronchial tree is damaged, as well as against the background of diseases of the larynx or pharynx. In this case, blood loss is an average of 50 milliliters per day. The main cause of the disease is damage to the main vascular pulmonary bundle.
As a rule, mortality due to such bleeding ranges from ten to seventy percent. This disease most often affects people who are over fifty years old. Basically, the pathology affects men who smoke for a long time or those who suffer from pulmonary dysfunction.
Forms
Pulmonary hemorrhage in medicine is divided into the following three forms:
- Small type of bleeding. In this case, blood loss is up to 100 milliliters per day.
- Middle type. Against the background of this form, blood secretion is up to 500 milliliters per day.
- Large form of selection. Against the background of this form, blood secretion is more than 500 milliliters per day.
Massive bleeding, occurring spontaneously in a short period of time, is considered the most dangerous. They very often result in death due to acute asphyxiation. Pulmonary hemorrhage, among other things, is internal with the occurrence of hemothorax, external and mixed.
Causes of pathology
Pulmonary hemorrhage is a polyetiological condition caused by diseases of internal organs, traumatic injury, and also an external and invasive chemical effect.
The leading place among the causes of bleeding belongs to infectious pathologies of the bronchi and lungs, the causative agents of which destroy the walls of blood vessels and alveoli. Tuberculosis, staphylococcal, pneumococcal, meningococcal and parasitic infections affect the lung parenchyma with the subsequent development of infiltrates and cysts. In more rare cases, the following respiratory tract pathologies can cause pulmonary bleeding:
- the presence of pneumosclerosis;
- the presence of benign neoplasms of the bronchopulmonary system;
- the development of lung cancer;
- the appearance of pulmonary infarction;
- the occurrence of arrosion of blood vessels and pneumoconiosis.
The following diseases are directly related to the blood circulation of the lungs, they lead to the appearance of bleeding from this organ. We are talking about heart defects, pulmonary thromboembolism, hypertension, cardiosclerosis and coronary heart disease. Pulmonary hemorrhages also occur in some systemic diseases in the form of vasculitis, diathesis, rheumatism, capillaritis, pulmonary hemosiderosis, and Goodpasture syndrome. The factors that contribute to the development of bleeding from the lungs include the following reasons:
- Conducting prolonged and uncontrolled anticoagulant therapy.
- Incomplete hemostasis during the early postoperative period.
- The presence of foreign objects in the bronchi.
- The presence of mental and emotional stress.
- Irradiation of the body along with a reaction to drugs.
- The effect of toxic components on the body.
- Transplantation of bone marrow and other organs.
- The appearance of venous stasis in the pulmonary circulation.
The risk group, as a rule, are those who suffer from acute pneumonia, diabetes and pulmonary tuberculosis. Also, pregnant women, people who take glucocorticoids, and, in addition, children who often suffer from pneumonia, are susceptible to this disease. The risk group includes elderly people and citizens with a low socio-economic status.
What are the signs of pulmonary hemorrhage?
Symptoms of the disease
Patients may complain of a strong, and at the same time, persistent dry cough. Over time, this can become wet, mucous sputum occurs, which, in turn, is mixed with foamy blood clots. Patients may experience the following symptoms of pulmonary hemorrhage:
- The presence of hemoptysis, shortness of breath and weakness.
- The appearance of discomfort and pain in the chest area.
- The appearance of fever.
- The presence of pallor and marbling of the skin.
- The development of central cyanosis.
- The appearance of a rapid heartbeat.
- The occurrence of wheezing, hypotension, a scared appearance and dizziness.
Hemoptysis and pulmonary hemorrhage often accompany each other. At the same time, patients feel quite satisfactory, since blood is released very slowly and very little from the body.
Pulmonary hemorrhages usually occur suddenly, against the background of complete well-being. Against this background, patients at first rarely cough up. The presence of redness of sputum may indicate slight tissue damage. Gradually, coughing can become more frequent and stronger with the release of a significant amount of bloody sputum. Signs of pulmonary hemorrhage may be exacerbated.
Over time, the cough becomes extremely severe, it is almost impossible to stop. Massive bleeding can be manifested by visual impairment, convulsive syndrome, fainting, asphyxia and dyspepsia.
Next, consider the diseases in which people can have pulmonary hemorrhages.
Emergency care is provided below.
Tuberculosis lesion
Tuberculous damage to the lung tissue with the destruction of the main structure of the organ can manifest intoxication syndrome, and, in addition, malaise, dry cough, low-grade fever, chest pain. The appearance of hemoptysis in this case can worsen the course of the disease, shortness of breath occurs along with acrocyanosis, fever, chills and profuse sweat. In this case, the cough becomes wet, and all the clinical symptoms of the pathology become most pronounced.
The causes of pulmonary hemorrhage should be determined by the doctor.
Bronchiectasis
Hemoptysis is one of the main signs of bronchiectatic pathology, indicating pronounced destructive processes. The clinical signs of the disease include recurrent cough along with wheezing, shortness of breath, chest pain, fever, decreased ability to work, exhaustion, developmental delay, puffiness of the face, and so on.
Emergency care for pulmonary hemorrhage is very important.
Lung abscess
An abscess of the lung can manifest as hemoptysis. In this case, the patient secretes purulent, and at the same time, fetid sputum, after which temporary relief may come. Clinically, against the background of this picture, the symptoms of severe intoxication prevail.
Lungs' cancer
Lung cancer can manifest as hemoptysis, and in addition, pulmonary hemorrhage. The growth of tumor tissues and their decay lead to direct destruction of the bronchi, and at the same time to the defeat of blood vessels. At the first stage of the disease, patients are disturbed by a painful cough, which turns into wet over time. Patients on the background of this disease lose weight dramatically, and they also have an increase in regional lymph nodes. Pulmonary hemorrhages in lung cancer often end in the death of the patient. Diagnosis of pathology is based on the clinical picture, and, in addition, on characteristic radiological symptoms.
Silicosis
Along with other pneumoconioses, hemoptysis is manifested. Directly in the terminal stages, patients develop pulmonary hemorrhage. Persons who work in dusty conditions with particles of quartz are most susceptible to the development of this pathology.
With pulmonary hemorrhage, everyone should know the emergency care algorithm.
Diagnostics
Doctors of various specialties are involved in the diagnosis and treatment of such a dangerous condition as pulmonary hemorrhage. The most informative diagnostic methods are the following research methods:
- Conducting a general visual examination, percussion and auscultation.
- Performing an X-ray or ultrasound examination of the lungs.
- Conducting magnetic resonance or computed tomography.
- Performing bronchial arteriography and angiopulmonography.
- The implementation of echocardiography, which is carried out in order to exclude mitral stenosis.
- Performing a general blood test along with a coagulogram.
- Conducting a microbiological examination of sputum in order to determine the etiology of bleeding.
- Taking a biopsy along with the study of polymerase chain reaction.
- Performing serological tests.
Bronchoscopy is most often used to detect sources of bleeding. As part of this procedure, medical workers take wash water for analysis, perform a biopsy from pathologically altered areas, and also perform a procedure to stop bleeding. Recurrent pulmonary hemorrhage is detected by contrast radiographs. The contrast medium is introduced through the catheter into the peripheral arteries, and after a certain period of time a series of images is taken.
The emergency care algorithm for pulmonary hemorrhage is presented below.
Emergency care
First aid against a background of internal bleeding is extremely limited. Such patients are urgently hospitalized in the department of surgery or pulmonology. Transportation is carried out in a sitting position with legs down.
Emergency care involves the removal of blood from the respiratory canals through a special aspirator. In addition, hemostatic drugs and antibiotics are introduced, blood components are transfused along with therapeutic bronchoscopy and surgical treatment.
The emergency care algorithm for pulmonary hemorrhage and patient treatment includes general recommendations for swallowing ice cubes, drinking small amounts of cold water and applying cold compresses to the chest. It is very important to calm such patients, explaining to them the need to cough up sputum. Excessive emotional stress can only aggravate the situation.
In the department, patients are placed on the sick side, they are inhaled oxygen with the necessary medications. A bronchoscopy is performed, and if necessary, the optimal amount of surgical intervention is determined. In this case, we are talking about lung resection or pneumonectomy.
There are temporary and final methods of first aid for pulmonary hemorrhage, aimed at stopping it. Temporary include drug hypotension, hemostatic drugs and endobronchial hemostasis techniques. And the majority of operations, such as lung resection, vascular ligation, and so on, are related to the second group.
Conservative treatment
Help with pulmonary bleeding is important to provide in a timely manner.
The treatment is aimed at eliminating the underlying disease. Today, drugs are used only for small and medium forms of pulmonary hemorrhage. The drugs that are prescribed for patients with this diagnosis are usually as follows:
- Treatment with hemostatic drugs in the form of “Vikasol”, “Sodium Etamsylate”, “Gordox” and “Contrikal”.
- The use of antihypertensive drugs is reduced to the use of "Pentamine", "Benzohexonia", "Arfonada" and "Clonidine."
- Treatment with immunosuppressants and glucocorticoids, for example, Cyclophosphamide.
- Painkillers are also used, for example, Analgin, some narcotic analgesics and Ketorol.
- To suppress a painful cough, drugs in the form of Codeine, Dionin, Promedol, Strofantin, and Korglikon are used.
- Treatment with desensitizing drugs in the form of Pipolfen and Diphenhydramine.
- Among diuretics, Lasix is most often preferred.
In the framework of erythrocyte mass replacement therapy against the background of significant blood loss, patients are given Polyglyukin and Reopoliglyukin. Salt solutions, Trisol and Ringer may also be used. In order to stop bronchospasm, Alupent is administered to patients along with Salbutamol and Berotek.
The use of endoscopic methods
Against the backdrop of the ineffectiveness of conservative treatment, doctors are moving to bronchoscopy, in which pulmonary bleeding stops in different ways. To do this, specialists use applications with drugs, a hemostatic sponge is installed, and vessels in the affected area are coagulated. In addition, the bronchi are obstructed with fillings and arteries are embolized. But these techniques bring only temporary relief.
X-ray endovascular occlusion of bleeding vessels is carried out by experienced radiologists who are fluent in the technique of angiography. Thanks to arteriography, doctors are able to determine the source of bleeding. In order to embolize blood vessels, polyvinyl alcohol is used. This method of treatment of pulmonary hemorrhage is quite highly effective. But it can cause a number of all kinds of complications, ranging from myocardial ischemia, ending with brain pathologies.
So with pulmonary hemorrhage, emergency care is not all.
Surgical treatment
The main types of operations are:
- Palliative interventions in the form of collapse therapy, thoracoplasty, pulmonary artery ligation and pneumotomy.
- Radical techniques include partial resection of the lung along with segmentectomy, lobectomy, bilobectomy, and pneumonectomy.
The death of a patient with massive bleeding most often occurs due to asphyxiation, and not due to blood loss.
We examined pulmonary hemorrhage and an aid algorithm.