Hemoptysis in Trauma

In an attempt to more clearly delineate the importance and pathophysiology of moderate-severe hemoptysis, a clinical and experimental study was performed. The clinical portion consisted of a retrospective review of 344 patients undergoing thoracotomy for penetrating trauma. There were 138 patients with injuries to the trachea, mainstem bronchi or lungs. Six with GSW to the chest had severe hemoptysis in the Emergency Department (ED) and had a cardiac arrest just after endotracheal intubation. At thoracotomy, all six had air in their coronary arteries and could not be resuscitated, Of 14 patients with posterolateral OR thoracotomies, three had significant (20–30 mm Hg) drops in systolic pressure plus increased aspiration of blood into the dependent lung when turned onto their sides. Of 12 patients surviving surgery, six with continued aspiration of blood required prolonged ventilatory support.In an experimental study, minimally heparinized (0.07 units/ml) blood was infused into the lower trachea of 17 anesthetized normovolemic supine dogs at 0.15 ml/kg/min. The PaO2 fell from 100 ± 11 to 65 ± 16 mm Hg after infusion of 4.5 ml/kg of blood. At the same time peak ventilator pressure rose only minimally (8.5 ± 1.7 to 11.2 ± 3.1 mm Hg). The PCO2, mean PA pressure, PAWP, CVP, and cardiac output were essentially unchanged.In a second study of 18 dogs, reducing the systolic BP by one third reduced cardiac output by almost 48% and oxygen transport by 58%. After 4.5 ml/kg blood were infused into the trachea, the PaO2 fell from 84 ± 19 to 52 ± 9 mm Hg. This resulted in a further drop in O2 transport to 36% of control with minimal changes in other parameters.