Severe Hemoptysis in ICU Patients: Shift in Leading Causes and Management Strategies

Strategic Insights -

A recent study published in Annals of Intensive Care has shed light on the changing clinical characteristics, etiologies, and outcomes of severe hemoptysis (SH) in intensive care unit (ICU) patients. The research, conducted at Sorbonne University, analyzed patients admitted for SH between 2009 and 2019 and compared the findings to a historical cohort from 1995-2009. The study revealed that lung cancer has become the leading cause of SH, surpassing bronchiectasis, tuberculosis, and pneumonia.

Key Takeaways:

  • The study analyzed 945 patients (75% males, median age 55 years) with respiratory comorbidities, with invasive mechanical ventilation required in 13% within 24 hours of ICU admission.
  • Lung cancer was the leading cause of SH, followed by bronchiectasis, tuberculosis, pneumonia, and aspergillosis.
  • Pneumonia-related hemoptysis increased significantly (11% vs. 5%; P=0.01), as did pulmonary arterial involvement (12% vs. 5%; P=0.01), mainly associated with pneumonia, cancer, or aspergillosis.
  • Vascular interventional radiology (VIR) was first attempted in 81% of cases, achieving bleeding control in more than 90% of cases.
  • Major adverse events occurred in 4.4% of cases, and emergent surgical lung resection was performed in 2% of cases, all after VIR.
  • The in-hospital mortality rate increased slightly (8.7% vs. 6.5%; P=0.08).
  • The study concluded that in-hospital mortality slightly increased, driven by a higher proportion of lung cancer.

Statistics:

  • 945 patients were analyzed in the study (75% males, median age 55 years).
  • Lung cancer accounted for 35% of SH cases.
  • Pneumonia-related hemoptysis increased by 6% over the past decade (11% vs. 5%).
  • Pulmonary arterial involvement increased by 7% over the past decade (12% vs. 5%).
  • VIR achieved bleeding control in 90% of cases.
  • Major adverse events occurred in 4.4% of cases.
  • In-hospital mortality rate increased slightly, from 6.5% to 8.7%.

Sources:

  • Severe Hemoptysis: Etiologies, Management, and Outcomes From a Single-center Experience Over the Last Decade. Annals of Intensive Care, 2025;15(1).