Massive Hemoptysis

Hemoptysis is the expectoration of gross blood or blood-streaked sputum. Hemoptysis is classified as massive or nonmassive based on the rate of bleeding. Expectoration of less than 100 mL of blood in a 24-hour period is considered nonmassive hemoptysis. The definition of massive hemoptysis varies widely in the literature, ranging between 100 and 600 mL of blood in a 24-hour period; however, the most commonly used definition is 600 mL in 24 hours.1 It is estimated that more than 400 mL of blood in the alveolar space is sufficient to cause impairment of oxygenation.2 Most cases of hemoptysis, both massive and nonmassive, are self-limited and resolve spontaneously. In a survey study of 230 chest physicians, 86% indicated that they had treated patients with massive hemoptysis during the previous year, and 28% reported death from pulmonary hemorrhage.3 Asphyxia rather than exsanguination is usually the cause of death,4 and it is commonly accompanied by cardiovascular collapse. The death rate from untreated massive hemoptysis ranges from 30% to 85% in multiple studies.1,5–8 Among patients who survive the initial hemorrhagic episode, bleeding ceases in 75% of cases within 24 hours, and in all cases by day 5.9