Navegando por Palavras-chave "Acute respiratory failure"

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    Correlation between surgical lung biopsy and autopsy findings and clinical data in patients with diffuse pulmonary infiltrates and acute respiratory failure
    (Faculdade de Medicina / USP, 2006-10-01) Canzian, Mauro; Soeiro, Alexandre de Matos; Taga, Marcel Frederico de Lima [UNIFESP]; Barbas, Carmen Silvia Valente; Capelozzi, Vera Luiza; São Paulo University Medical School Heart Institute Divisions of Respiratory Diseases and Pathology; São Paulo University Medical School Hospital das Clínicas Department of Pathology; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: Surgical lung biopsy is an invasive procedure performed when other procedures have failed to provide an urgent and specific diagnosis, but there may be reluctance to perform it in critically ill patients with diffuse pulmonary infiltrates. PURPOSE: To evaluate the diagnostic accuracy, the changes in therapy and survival of patients with diffuse lung infiltrates, mostly presenting acute respiratory failure, who underwent surgical biopsy. METHODS: We retrospectively examined medical records and surgical lung biopsies from 1982 to 2003 of 63 patients older than 18 years with diffuse infiltrates. Clinical diagnoses were compared to histopathological ones, from biopsies and autopsies. Laboratory and epidemiological data were evaluated, and their relationship to hospital survival was analyzed. RESULTS: All histological specimens exhibited abnormalities, mostly presenting benign/inflammatory etiologies. Fifteen patients had an etiologic factor determined in biopsy, most commonly Mycobacterium tuberculosis. The preoperative diagnosis was rectified in 37 patients. Autopsies were obtained in 25 patients and confirmed biopsy results in 72% of cases. Therapy was changed for 65% of patients based on biopsy results. Forty-nine percent of patients survived to be discharged from the hospital. Characteristics that differed significantly between survivors and nonsurvivors included sex (P = 0.05), presence of comorbidity (P = 0.05), SpO2 (P = 0.05), and presence of diffuse alveolar damage in the biopsy (P = 0.004). CONCLUSION: Surgical lung biopsy provided a specific, accurate etiologic diagnosis in many patients with diffuse pulmonary infiltrates when clinical improvement did not occur after standard treatment. Surgical lung biopsy may reveal a specific diagnosis that requires distinct treatment, and it would probably have an impact in lowering the mortality of these patients.
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    Uso do suporte ventilatório com pressão positiva contínua em vias aéreas (CPAP) por meio de máscara nasofacial no tratamento da insuficiência respiratória aguda
    (Associação Médica Brasileira, 1997-09-01) Scarpinella-bueno, M.a. [UNIFESP]; Llarges, C.m. [UNIFESP]; Isola, A.m. [UNIFESP]; Holanda, M.a. [UNIFESP]; Rocha, R.t. [UNIFESP]; Afonso, J.e. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE. To evaluate the efficacy of continuous positive airway pressure (CPAP) administered by face mask in patients with acute respiratory failure with indication of mechanical ventilation. MATERIALS AND METHOD. Eleven patients (mean age 41.3 years) in acute respiratory failure were admitted in the Respiratory Unit - Hospital São Paulo - Escola Paulista de Medicina. At the admission pH, PaO2, PaCO2, respiratory rate (f), arterial pressure and heart rate were measured. The measurements were repeated with administration of oxigen with a high flow face mask at ambient airway pressure and then with 5cm H2O of CPAP by face mask. RESULTS. The use of CPAP by face mask significantly improved the arterial blood oxigenation and decreased the respiratory rate (p<0.05). CONCLUSION. These data allow the conclusion that CPAP administered by face mask improves gas exchange and decreases respiratory rate in patients with acute respiratory failure and may reduce the need for invasive mechanical ventilation.