Hemorrhaging: Pulmonary hemorrhage (P-Hem) – TheTreatments
Home of Kyle J. Norton for The Better of Living & Living Health Hemorrhaging is
also known as bleeding or abnormal bleeding as a result of blood loss due to
internal.external leaking from blood vessels or through the skin.
I. Classifications of Hemorrhaging
According to the classification from the American College of Surgeons’ Advanced Trauma Life Support (ATLS), Hemorrhaging is divided into 4 classes, depending to the volumes of blood loss and other factors
According to the classification from the American College of Surgeons’ Advanced Trauma Life Support (ATLS), Hemorrhaging is divided into 4 classes, depending to the volumes of blood loss and other factors
Classification of hemorrhage
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Class
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Parameter
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I
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II
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III
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IV
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Blood loss (ml)
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<750
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750–1500
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1500–2000
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>2000
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Blood loss (%)
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<15%
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15–30%
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30–40%
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>40%
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Pulse rate (beats/min)
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<100
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>100
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>120
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>140
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Blood pressure
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Normal
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Decreased
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Decreased
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Decreased
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Respiratory rate (breaths/min)
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14–20
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20–30
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30–40
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>35
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Urine output (ml/hour)
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>30
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20–30
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5–15
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Negligible
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CNS symptoms
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Normal
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Anxious
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Confused
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Lethargic
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Modified from Committee on Trauma. CNS = central nervous system(1a).
II. Types of hemorrhaging E.4. Treatments
Treatments depend on the diagnosis of each patient, if the underlined cause is due to medication, then medicine has to be stopped.
1. Immediate treatment
According to the Intensive Care Nursery House Staff Manual immediate treatment of P-Hem should include tracheal suction, oxygen and positive pressure ventilation. To assist in decreasing P-Hem, mean airway pressure should be increased, either by a relatively high PEEP (i.e., 6 to 10 cmH2O) or by high frequency ventilation(15). In the infants, reserachers at suggested that current management of PH in VLBW infants includes ventilatory support using high positive end expiratory pressure, transfusion of blood and blood products to support the circulation and correct any hemostatic or coagulation defects and evaluation and treatment for patent ductus arteriousus (PDA). These strategies are often ineffective in preventing a poor outcome. rFVIIa is effective in controlling life-threatening hemorrhage in patients with hemophilia A and B with inhibitors, and innonhemophiliacs with a variety of inherited or acquired hemostatic defects including platelet disorders, liver disease and von Willebrand’s disease.(15a)
Treatments depend on the diagnosis of each patient, if the underlined cause is due to medication, then medicine has to be stopped.
1. Immediate treatment
According to the Intensive Care Nursery House Staff Manual immediate treatment of P-Hem should include tracheal suction, oxygen and positive pressure ventilation. To assist in decreasing P-Hem, mean airway pressure should be increased, either by a relatively high PEEP (i.e., 6 to 10 cmH2O) or by high frequency ventilation(15). In the infants, reserachers at suggested that current management of PH in VLBW infants includes ventilatory support using high positive end expiratory pressure, transfusion of blood and blood products to support the circulation and correct any hemostatic or coagulation defects and evaluation and treatment for patent ductus arteriousus (PDA). These strategies are often ineffective in preventing a poor outcome. rFVIIa is effective in controlling life-threatening hemorrhage in patients with hemophilia A and B with inhibitors, and innonhemophiliacs with a variety of inherited or acquired hemostatic defects including platelet disorders, liver disease and von Willebrand’s disease.(15a)
2. Embolization – Interventional treatment of pulmonary arteriovenous
malformations
Acording to the study of Dr. Andersen PE and Dr. Kjeldsen AD. at the Odense University Hospital ”Pulmonary arteriovenous malformations (PAVM) are congenital vascular communications in the lungs. The generally accepted treatment strategy of first choice is embolization of the afferent arteries to the arteriovenous malformations. It is a minimally invasive procedure and at the same time a lungpreserving treatment with a very high technical success, high effectiveness and low morbidity and mortality. Embolization prevents cerebral stroke and abscess as well as pulmonary haemorrhage and further raises the functional level. Embolization is a well-established method of treating PAVM, with a significant effect on oxygenation of the blood. Screening for PAVM in patients at risk is recommended, especially in patients with HHT(16).
Acording to the study of Dr. Andersen PE and Dr. Kjeldsen AD. at the Odense University Hospital ”Pulmonary arteriovenous malformations (PAVM) are congenital vascular communications in the lungs. The generally accepted treatment strategy of first choice is embolization of the afferent arteries to the arteriovenous malformations. It is a minimally invasive procedure and at the same time a lungpreserving treatment with a very high technical success, high effectiveness and low morbidity and mortality. Embolization prevents cerebral stroke and abscess as well as pulmonary haemorrhage and further raises the functional level. Embolization is a well-established method of treating PAVM, with a significant effect on oxygenation of the blood. Screening for PAVM in patients at risk is recommended, especially in patients with HHT(16).
3. Corticosteroids
There is a report of a patient suffered from acute glomerulonephritis with modest renal impairmentand life-threatening pulmonary hemorrhage. The pulmonary hemorrhage caused severe hypoxia thatnecessitated artificial ventilation. As a last resort, 1 g/day of methylprednisolone was administered intravenously. Rapid cessation of pulmonary hemorrhage ensued with clearing of the lungs fields. the suggestion of large doses of glucocorticosteroids should be administered to patients with life-threatening pulmonary hemorrhage before considering bilateral nephrectomy, especially if the renal function is still adequate. Bilateral nephrectomy is an irreversible approach and, as with massive doses of steroids, has yet to be proved to be a consistently effective mode of therapy(17).
SourcesThere is a report of a patient suffered from acute glomerulonephritis with modest renal impairmentand life-threatening pulmonary hemorrhage. The pulmonary hemorrhage caused severe hypoxia thatnecessitated artificial ventilation. As a last resort, 1 g/day of methylprednisolone was administered intravenously. Rapid cessation of pulmonary hemorrhage ensued with clearing of the lungs fields. the suggestion of large doses of glucocorticosteroids should be administered to patients with life-threatening pulmonary hemorrhage before considering bilateral nephrectomy, especially if the renal function is still adequate. Bilateral nephrectomy is an irreversible approach and, as with massive doses of steroids, has yet to be proved to be a consistently effective mode of therapy(17).
(1a) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065003/table/T1/
(15) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf
(15a) http://www.nature.com/jp/journal/v22/n8/full/7210787a.html
(16) http://www.ncbi.nlm.nih.gov/pubmed/21160695
(17) http://annals.org/article.aspx?articleid=689575
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