Management Paediatric notes Recommendation strategy study population Antifibrinolytics No Adult studies suggest a Maintain adequate platelet to prevent benefit of antifibrinolytics count and correct haemoptysis in prevention of bleeding coagulation abnormalities and reducing platelet where clinically transfusions, but data too appropriate. limited to recommend widespread use (69). Antifibrinolytics should be considered on an individual patient basis Antifibrinolytics No Adult studies suggest a Tranexamic acid should to stop role for tranexamic acid be considered for use in haemoptysis in reducing the duration children with active and volume of bleeding haemoptysis. (70). Symptomatic No No evidence found to Despite a lack of evidence management suggest symptomatic to support symptomatic management with management of anxiolytics and opioids is haemoptysis, individual effective. patients may benefit from management of anxiety and dyspnoea. Table 5: Symptomatic management of retained secretions at the end of life Management Paediatric notes Recommendation strategy study population Simple No No studies looking at the Simple measures should interventions benefit of simple be considered prior to interventions such as drug management. Care suctioning, postural should be taken with drainage or positioning suctioning to avoid trauma.
Management strategy Paediatric study population notes Recommendation Antifibrinolytics to prevent haemoptysis No Adult studies suggest a benefit of antifibrinolytics in prevention of bleeding and reducing platelet transfusions, but data too limited to recommend widespread use (69). Maintain adequate platelet count and correct coagulation abnormalities where clinically appropriate. Antifibrinolytics should be considered on an individual patient basis Antifibrinolytics to stop haemoptysis No Adult studies suggest a role for tranexamic acid in reducing the duration and volume of bleeding (70). Tranexamic acid should be considered for use in children with active haemoptysis. Symptomatic management No No evidence found to suggest symptomatic management with anxiolytics and opioids is effective. Despite a lack of evidence to support symptomatic management of haemoptysis, individual patients may benefit from management of anxiety and dyspnoea. Table 5: Symptomatic management of retained secretions at the end of life Management strategy Paediatric study population notes Recommendation Simple interventions No No studies looking at the benefit of simple interventions such as suctioning, postural drainage or positioning Simple measures should be considered prior to drug management. Care should be taken with suctioning to avoid trauma.