Severe respiratory failure due to diffuse alveolar hemorrhage: Clinical characteristics and outcome of intensive care

Rabe, Christian; Appenrodt, Beate; Hoff, Christian; Ewig, Santiago; Klehr, Hans Ulrich; Sauerbruch, Tilman; Nickenig, Georg; Tasci, Selçuk

doi:10.1016/j.jcrc.2009.04.009

« Previous Next »Journal of Critical Care
Volume 25, Issue 2 , Pages 230-235, June 2010

Severe respiratory failure due to diffuse alveolar hemorrhage: Clinical characteristics and outcome of intensive care

Christian Rabe, MD, MBA
- Medical ICU, Department of Internal Medicine I, University of Bonn, D-53105 Bonn, Germany
- Corresponding author. Tel.: +49 228 28715507; fax: +49 228 28714698.
- C.R. and B.A. contributed equally.
Beate Appenrodt, MD
- Medical ICU, Department of Internal Medicine I, University of Bonn, D-53105 Bonn, Germany
- C.R. and B.A. contributed equally.
Christian Hoff, MD
- Medical ICU, Department of Internal Medicine II, University of Bonn, D-53105 Bonn, Germany
Santiago Ewig, MD, FCCP
- Medical ICU, Department of Internal Medicine II, University of Bonn, D-53105 Bonn, Germany
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Herne und Bochum, D-44651 Herne, Germany
Hans Ulrich Klehr, MD
- Medical ICU, Department of Internal Medicine I, University of Bonn, D-53105 Bonn, Germany
Tilman Sauerbruch, MD
- Medical ICU, Department of Internal Medicine I, University of Bonn, D-53105 Bonn, Germany
Georg Nickenig, MD
- Medical ICU, Department of Internal Medicine II, University of Bonn, D-53105 Bonn, Germany
Selçuk Tasci, MD
- Medical ICU, Department of Internal Medicine II, University of Bonn, D-53105 Bonn, Germany

published online 10 July 2009.

Abstract

Background

The aim of this study was to characterize patients and report outcome of diffuse alveolar hemorrhage (DAH) requiring intensive care unit support.

Patients and Methods

Thirty-seven patients were identified. Clinical characteristics and outcome were determined by chart review.

Results

Eighty-nine percent of patients presented with shortness of breath, 23% with cough, and 3% with hemoptysis. In 9% of patients, a diagnosis of DAH was suspected on admission. Diagnosis was confirmed by finding a progressively hemorrhagic bronchoalveolar lavage fluid in 89% and by a positive iron stain in 11% of patients. Vasculitis was causative in 19%, drug toxicity in 11%, thrombocytopenia in 27%, stem-cell transplantation in 5%, sepsis-associated lung injury in 22%, and unknown mechanisms in 16%. Thirty-two patients were mechanically ventilated, 4 received noninvasive ventilation, and 1 received supplemental oxygen therapy. Overall, 18 (49%) of 37 patients survived the intensive care unit stay. Survival was markedly different between patients with an immunologic/unknown etiology (82%) and patients with thrombocytopenia and/or sepsis (22%).

Discussion

Diffuse alveolar hemorrhage should be considered in all patients with persistent pulmonary infiltrates. Both bronchoalveolar lavage fluid and iron stain are mandatory diagnostic means. Patients with an immunologic/idiopathic pathogenetic mechanism have a relatively good prognosis, whereas the outcome in individuals with DAH secondary to cancer therapy or sepsis is poor.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation, ARDS, acute respiratory distress syndrome, ANCAs, antineutrophile cytoplasmic antibodies, BAL, bronchoalveolar lavage, DAH, diffuse alveolar hemorrhage, ICU, intensive care unit, MODS, multiorgan dysfunction score