Management of severe acute pulmonary haemorrhage in children.

Abstract

Pulmonary haemorrhage is a potentially life-threatening condition with a variety of causes. Quality clinical trials are insufficient in children, restricting the evidence base to observational data and adult studies. The overall management strategy should address control of symptomatic bleeding, identification of the bleeding source, and treatment of the underlying cause. Flexible bronchoscopy is an important tool used to identify the cause and site of bleeding, do interventional procedures, and directly instil medications to affected areas. Medications to control bleeding include vasoconstrictors, antifibrinolytics, and recombinant factor VIIa. Definitive treatment often requires immunomodulatory medications, bronchial artery embolisation, or surgery. In this Review, we summarise the most recent evidence pertaining to medical, interventional, and surgical treatments of pulmonary haemorrhage in children.