Pulmonary bleeding is a very serious condition caused by the outflow of blood into the bronchial area. It requires urgent medical attention. Pulmonary bleeding is a dangerous complication of various respiratory, hematological and cardiac diseases. This pathology has a second name - diffuse alveolar bleeding syndrome. Bloody discharge from the vessels is formed due to a violation of their integrity, and, in addition, due to the collapse of lung tissues. Intense blood loss can dramatically worsen the patient's well-being, disrupting the work of the heart, respiratory tract, and, at the same time, the blood-forming organs.
Basic information about the disease
Pulmonary bleeding, 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 is generally not life threatening and is considered less of a he alth hazard. 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 averages 50 milliliters per day. The main cause of the disease is damage to the main vascular pulmonary bundle.
Typically, mortality due to such bleeding ranges from ten to seventy percent. This disease most often affects people over the age of fifty. Basically, the pathology affects men who smoke for a long time or those who suffer from pulmonary dysfunction.
Shapes
Pulmonary bleeding in medicine is divided into three forms:
- Small type of bleeding. In this case, blood loss is up to 100 milliliters per day.
- Average type. Against the background of this form, the release of blood is up to 500 milliliters per day.
- Large selection form. Against the background of this form, the release of blood is more than 500 milliliters per day.
The most dangerous is considered to be massive bleeding in terms of total volume, occurring spontaneously in a short period of time. They very often end in death due to acute asphyxia. Pulmonary bleeding, among other things, is internal with the occurrence of hemothorax, external and mixed.
Reasonspathology
Pulmonary hemorrhage is a polyetiological condition caused by diseases of the internal organs, traumatic injury, as well as external and invasive chemical influences.
The leading cause of bleeding belongs to infectious pathologies of the bronchi and lungs, the pathogens 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 pathologies of the respiratory tract can cause pulmonary bleeding:
- presence of pneumosclerosis;
- presence of benign neoplasms of the bronchopulmonary system;
- development of lung cancer;
- appearance of pulmonary infarction;
- occurrence of arrosion of vessels and pneumoconiosis.
The following diseases are directly related to the bloodstream of the lungs, and they lead to bleeding from this organ. We are talking about heart defects, pulmonary embolism, hypertension, cardiosclerosis and coronary heart disease. Pulmonary bleeding also occurs in some systemic diseases in the form of vasculitis, diathesis, rheumatism, capillaritis, pulmonary hemosiderosis and Goodpasture's syndrome. Factors that contribute to the development of bleeding from the lungs include the following reasons:
- Prolonged and uncontrolled anticoagulant therapy.
- Incomplete control of bleeding during the early postoperative period.
- Presence of foreign objects in the bronchi.
- Presence of mental and emotional strain.
- Irradiation of the body along with drug reactions.
- The effect of toxic components on the body.
- Performing 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. Pregnant women, people who take glucocorticoids, and, in addition, children who often suffer from pneumonia are also susceptible to this disease. The risk group includes the elderly and citizens with low socioeconomic status.
What are the signs of pulmonary hemorrhage?
Symptoms of disease
Patients may complain of a strong, and at the same time persistent dry cough. Over time, this can become moist, resulting in mucous sputum, which, in turn, is mixed with foamy blood clots. Patients may experience the following symptoms of pulmonary hemorrhage:
- 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.
- Development of central cyanosis.
- Appearance of palpitations.
- Occurrence of wheezing, hypotension, frightened appearance and dizziness.
Hemoptysis and pulmonarybleeding often accompany each other. At the same time, patients feel quite satisfactory, since the blood is excreted very slowly and very little from the body.
Pulmonary bleeding usually occurs suddenly, against the background of complete well-being. Against this background, patients at first infrequently clear their throats. The presence of reddening of the sputum may indicate minor tissue damage. Gradually, the coughing may become more frequent and violent, producing a significant amount of bloody sputum. Signs of pulmonary hemorrhage may worsen.
Over time, the cough becomes extremely severe, it is almost impossible to stop. Massive bleeding can be manifested by visual impairment, convulsive syndrome, pre-syncope, asphyxia and dyspepsia.
Next, consider what diseases people may experience pulmonary bleeding.
Emergency care is listed below.
Tuberculosis lesion
Tuberculosis lesions of the lung tissues with the destruction of the main structure of the organ can be manifested by an intoxication syndrome, and, in addition, malaise, dry cough, subfebrile condition, 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. At the same time, the cough becomes wet, and all the clinical symptoms of the pathology become as pronounced as possible.
The causes of pulmonary bleeding should be investigated by a doctor.
Bronchoectaticdisease
Hemoptysis is one of the main signs of bronchiectasis pathology, indicating pronounced destructive processes. Clinical signs of the disease include recurrent cough along with wheezing, shortness of breath, chest pain, fever, disability, malnutrition, developmental delay, facial puffiness, and so on.
Emergency care for pulmonary hemorrhage is very important.
Lung abscess
A lung abscess may present with hemoptysis. In this case, the patient secretes purulent, and at the same time fetid sputum, after which temporary relief may occur. Clinically, against the background of this picture, the symptoms of severe intoxication predominate.
Lung cancer
Lung cancer can be manifested by hemoptysis, and, in addition, pulmonary bleeding. The growth of tumor tissues and their decay lead to direct destruction of the bronchi, and at the same time to damage to the blood vessels. At the first stage of the disease, patients are worried about a painful cough, which eventually turns into a wet one. Patients against the background of this disease lose weight dramatically, and they also have an increase in regional lymph nodes. Pulmonary bleeding in lung cancer often ends in the death of the patient. Diagnosis of pathology is based on the clinical picture, and, in addition, on the characteristic radiological symptoms.
Silicosis
Along with other pneumoconiosis, they are manifested by hemoptysis. Immediately in the terminal stages of patientspulmonary hemorrhage occurs. Persons who work in dusty conditions with quartz particles are most susceptible to the development of this pathology.
In case of pulmonary hemorrhage, everyone should know the emergency care algorithm.
Diagnosis
Diagnosis and treatment of such a dangerous condition as pulmonary hemorrhage is carried out by doctors of various speci alties. The most informative diagnostic methods are the following research methods:
- Perform general visual inspection, percussion and auscultation.
- Performing X-ray or ultrasound examination of the lungs.
- Carrying out magnetic resonance or computed tomography.
- Performing bronchial arteriography and angiopulmonography.
- Echocardiography performed to rule out mitral stenosis.
- Performing a complete blood count along with a coagulogram.
- Microbiological examination of sputum to determine the etiology of bleeding.
- Taking a biopsy along with studying the 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 manipulation to stop bleeding. Recurrent pulmonary bleeding is detected by contrast radiodiagnostics. contrast agentis inserted through a catheter into the peripheral arteries, and a series of images are taken after a certain period of time.
The emergency management algorithm for pulmonary hemorrhage is presented below.
Emergency assistance
First aid against 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 tract through a special aspirator. In addition, hemostatic drugs and antibiotics are administered, blood components are transfused along with therapeutic bronchoscopy and surgical treatment.
The emergency pulmonary hemorrhage and patient management algorithm 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 reassure such patients by explaining to them the need to cough up sputum. Excessive emotional strain can only aggravate the situation.
In the department, patients are placed on the affected side, they are given inhalation oxygen with the necessary medicines. 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 methodsfirst aid for pulmonary bleeding, aimed at stopping it. Temporary treatments include medical hypotension, hemostatic drugs, and endobronchial hemostasis techniques. And the second group is related to most operations such as lung resection, vascular ligation, and so on.
Conservative treatment
Help for pulmonary bleeding is important to provide in a timely manner.
Treatment is aimed at eliminating the underlying disease. Today, medications are used only for small and medium forms of pulmonary bleeding. The drugs that are prescribed to patients with this diagnosis are usually the following:
- Treatment with hemostatic drugs in the form of "Vikasol", "Etamsylate sodium", "Gordox" and "Kontrykal".
- The use of antihypertensive drugs is reduced to the use of Pentamin, Benzohexonium, Arfonade and Clonidine.
- Treatment with immunosuppressants and glucocorticoids, such as Cyclophosphamide.
- Painkillers are also used, for example, Analgin, some narcotic analgesics and Ketorol.
- To suppress a painful cough, drugs are used in the form of Codeine, Dionin, Promedol, Strophanthin and Korglikon.
- Treatment with desensitizing drugs in the form of Pipolfen and Dimedrol.
- Among diuretics, Lasix is most often preferred.
As part of the replacement therapy of erythrocyte mass against the background of significant blood loss, patients are given "Polyglukin" and "Reopoliglyukin". Also canapply saline solutions, "Trisol" and "Ringer". In order to stop bronchospasm, Alupent is administered to patients along with Salbutamol and Berotek.
Use of endoscopic techniques
Against the background of the ineffectiveness of conservative treatment, doctors turn to bronchoscopy, in which pulmonary bleeding is stopped in various ways. To do this, specialists use applications with drugs, a hemostatic sponge is installed and the vessels in the affected area are coagulated. Among other things, the bronchi are obturated with fillings and arteries are embolized. But these techniques only provide temporary relief.
X-ray endovascular occlusion of bleeding vessels is performed by experienced radiologists who are fluent in angiography techniques. Thanks to arteriography, doctors can determine the source of bleeding. In order to embolize blood vessels, polyvinyl alcohol is used. This method of treatment of pulmonary bleeding is quite highly effective. But it can cause all sorts of complications, ranging from myocardial ischemia to brain pathologies.
So for pulmonary hemorrhage, emergency care isn't everything.
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 lung resection along with segmentectomy, lobectomy,bilobectomy and pneumonectomy.
The death of a patient with massive bleeding is most often due to asphyxia, and not due to blood loss.
We looked at pulmonary hemorrhage and the algorithm of assistance.
