Inhaled Tranexamic Acid for the Management of Hemoptysis in a Patient With Right and Left Ventricular Assist Devices: A Case Report

Advances in the study of nebulized tranexamic acid for pulmonary hemorrhage

PURPOSE

Pulmonary hemorrhage is a life-threatening condition characterized by blood leakage into lung tissues, leading to severe respiratory distress. Nebulized tranexamic acid (TXA) has emerged as a promising treatment option for pulmonary hemorrhage due to its localized hemostatic effects and minimal systemic side effects. This review aims to summarize the research progress on the effectiveness and safety of nebulized TXA in pulmonary hemorrhage.

METHODS

A comprehensive search of the Embase, PubMed, and Scopus databases was conducted to identify relevant studies published between the date of inception of each database and November 2023. A comprehensive search was conducted in the PubMed, Embase, Scopus, and Google Scholar databases using the following keywords: "hemoptysis," "haemoptysis," "pulmonary hemorrhage," "tranexamic acid," "antifibrinolytic," "nebulize," and "inhale." Additional articles were identified by reviewing the references of the retrieved studies. Studies were selected based on their focus on the application of nebulized TXA for pulmonary hemorrhage. The authors and dates of publication, study type, patients, diseases, intervention and main outcomes of these papers are tabulated. This consisted of two randomized controlled trials (RCTs), six case series, and nine case reports.

RESULTS

The commonly used dosage of nebulized TXA in the studies reviewed was 500 mg/5 ml, administered 3-4 times daily. Evidence suggests that nebulized TXA effectively controls bleeding in pulmonary hemorrhage with a hemostatic efficacy comparable to systemic administration, but with a lower risk of venous thrombosis. Safety data indicates that nebulized TXA is generally well-tolerated, with no significant systemic adverse reactions reported. Local reactions, such as bronchospasm, were rare and resolved with short-term bronchodilator treatment.

CONCLUSION

Nebulized TXA appears to be an innovative and minimally invasive therapy for pulmonary hemorrhage, providing targeted hemostatic effects with a favorable safety profile. However, the predominance of small-scale studies and case reports highlights the need for large-scale, high-quality research to establish standardized guidelines.

Right Ventricular Assist Device With an Oxygenator for the Management of Combined Right Ventricular and Respiratory Failure: A Systematic Review

BACKGROUND

Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. Right ventricular assist device with an oxygenator (OxyRVAD) is an extracorporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarises the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure.

METHODS

PubMed, Embase, and Google Scholar were queried on September 27, 2023, for articles describing the use of an OxyRVAD configuration. The main outcome of interest was survival to intensive care unit (ICU) discharge. Data on the duration of OxyRVAD support and device-related complications were also recorded.

RESULTS

Out of 475 identified articles, 33 were retained for analysis. Twenty-one articles were case reports, and 12 were case series, representing a total of 103 patients. No article provided a comparison group. Most patients (76.4%) were moved to OxyRVAD from another type of mechanical support. OxyRVAD was used as a bridge to transplant or curative surgery in 37.4% and as a bridge to recovery or decision in 62.6%. Thirty-one patients (30.1%) were managed with the dedicated single-access dual-lumen ProtekDuo cannula. Median time on OxyRVAD was 12 days (interquartile range 8-23 days), and survival to ICU discharge was 63.9%. Device-related complications were infrequently reported.

CONCLUSION

OxyRVAD support is a promising alternative for RV support when gas exchange is compromised, with good ICU survival in selected cases. Comparative analyses in patients with RV failure with and without severe lung disease are needed.