Modified technique of endobronchial balloon tamponade for persistent hemoptysis

Endobronchial balloon tamponade has been used to control life-threatening hemoptysis. With the classical balloon tamponade technique, the bleeding airway is occluded by inflating a balloon catheter, which is passed through the bronchoscope. We describe a modified technique of endobronchial balloon tamponade with the introduction of the balloon catheter parallel to the bronchoscope, which allows keeping the balloon for a longer period and improves suction capacity. We report 3 patients with persistent hemoptysis who were successfully managed by this modified endobronchial balloon tamponade technique. In the 3 cases, a snare inserted through a bronchoscope is used to grasp a balloon catheter, outside the bronchoscope. After the correct position of the balloon proximal to the bleeding, the snare is removed and the balloon inflated. The bronchoscope is then withdrawn and the balloon is left in the airway. The balloon was kept inflated 72 hours in the bleeding airway in the first 2 cases with complete resolution of the hemoptysis. In the last case, the balloon was kept inflated 9 hours, until surgery. There are several advantages of this technique. As the balloon catheter is inserted outside the bronchoscope, it provides a better view because of the best suction ability, allowing adequate positioning of the balloon during the procedure. Moreover, the inflated balloon catheter can be left in place for long periods allowing a definitive control of the bleeding in some cases or a stabilization of the patient until more invasive and definitive solutions as bronchial artery embolization or surgery can be performed.