ICF syndrome

Rakesh C Gupta, MD(*); Ramakant Dixit, MBBS; M L Gupta, MD, DM and G D Khilnani, MD. Department of Chest Diseases & Pharmacology, J.L.N. Medical College, Ajmer, India.

PURPOSE: Hemoptysis is one of the commonest respiratory emmergency in cavitary pulmonary diseases and a significant event that is frightening to the patients & treating physicians alike. Oral & parenteral haemostatics in current use have variable success rate. The present clinical trial was done to evaluate the efficacy of sterile 1% Ferracrylum (insoluble, incomplete iron salt of polyacrylic acid) solution introduced directly into the pulmonary cavity in 32 patients with active hemoptysis.

METHODS: A prior institutional ethical committee approval was taken. The cavitary lesion was localised by clinico radiographic evidence in 32 randomly selected (fullfilling the eligibility criteria) cases (27 males; 5 females; age 19-58 years) of pulmoanry tuberculosis with single cavitary lesion. 5 to 10 ml of 1% sterile FERRACRYLUM was injected into cavity in 23 patients by percutaneous transthoracic approach using spinocan needle (22 G x 3 1/2" - B Bran, Melsungen AG, D-34209, Belgium) or intracath (21 G) under local anaesthesia and atropine premedication. In remaining 9 cases requiring bronchoscopy, the Ferracrylum was instilled directly through bronchoscope. The procedure was repeated on 2nd & 3rd day if needed. The immediate and long term response along with complications were assessed subsequently.

RESULTS: The diagnostic breakup of patients was active pulmonary tuberculosis in 20 patients (13 fresh cases, 5 relapse & 2 MDR cases) and healed pulmonary disease in 12 (8 open negative syndrome and 4 with aspergilloma). ICF resulted in an immediate (within minutes) cessation of hemoptysis in 21 (65.6%) and in all patients within 5 days. A direct blanching effect was observed during bronchoscopic instillation of drug. No recurrence was reported at one month followup. Long term control of hemoptysis was achieved in 27 (84.3%) patients for up to 1-6 months. Overall complications of ICF consisted giddiness persisting up to 24-36 hours and cough in 6 (18.7%), hypotension, pneumothorax and subcutaneous emphysema in one (3.1%) patients each. These patients recovered with intensive monitoring. No death was recorded.

CONCLUSION: ICF is well tolerated, feasible and effective alternative for control of hemoptysis due to cavitary pulmonary lesions.

CLINICAL IMPLICATIONS: This procedure may be used more frequently in cases of hemoptysis when conventional hemostatics fails. More over during bronchofibrescopy where there is significant bleed, ferracrylum may be used effectively and safely.

COPYRIGHT 2000 American College of Chest Physicians
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