What is the key question?

• Massive airway hemorrhage is difficult to define and to manage. The authors retrospectively analysed 223 cases of airway haemorrhage in an attempt to define the impact of hemorrhage on patients and to examine the treatment approach.

What is the bottom line?

• Massive airway haemorrhage occurs in only a small proportion of bronchoscopies. It is associated with significant differences in incidence of hypoxemia, shock, need for cardiopulmonary resuscitation (CPR), intubation/ admission to ICU and mortality.

Why read on?

• Using a defined criteria for massive haemorrhage of greater than 100mL blood loss, rapid bleeding leading to blurred bronchscopic view, difficult hemostasis and drop in SpO2 to less than 80%, the authors showed significantly worse outcomes in this group. Unsurprisingly, acute haemorrhage patients required more frequent use of intravenous hemostasis drugs, had greater blood loss volume, more often had hypoxemia and intraoperative mortality, transfer to ICU with intubation and required longer procedures to manage endobronchial pathologies, despite there being no difference in hemorrhage location or cause.
• Although this is a retrospective study, the authors conclude that the massive airway haemorrhage group benefit from endotracheal intubation to isolate one lung and ventilate it as it is the simplest and fastest method to ensure effective single lung ventilation. They argue other devices require more precise placement and better vision than the relatively straight-forward ET placement. The findings are intriguing and demand further investigation.