Navegando por Palavras-chave "Insuficiência respiratória aguda"
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- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)Manobra de recrutamento alveolar na contusão pulmonar: relato de caso e revisão da literatura(Associação de Medicina Intensiva Brasileira - AMIB, 2009-03-01) Trindade, Lívia Maria Vitório [UNIFESP]; Lopes, Lucianne Cristina da Silva [UNIFESP]; Cipriano, Graziella França Bernardelli [UNIFESP]; Vendrame, Letícia Sandre [UNIFESP]; Andrade Junior, Ary de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Treatment of pulmonary contusion when adequately established is very simple in most cases. Pathophysiological changes occur as a result of the effects produced by loss of chest wall integrity, accumulation of fluid in the pleural cavity, obstruction of the airways and lung dysfunction. The alveolar recruitment maneuver is the reopening of collapsed lung areas by increasing inspiratory pressure in the airway. The primary objective of this case report was to evaluate the effectiveness of the alveolar recruitment maneuver in a patient with pulmonary contusion. A 33 year old male patient, with a clinical condition of bilateral chest trauma and traumatic brain injury, evolved with reduction of the level of consciousness, acute respiratory failure, hypovolemic shock and hemoptysis. The patient underwent thoracentesis, bilateral thoracic drainage and was also submitted to invasive mechanical ventilation. After 48 hours of invasive mechanical ventilation, in accordance with protective strategy an alveolar recruitment maneuver mode, pressure-controlled ventilation, pressure controlled 10 cmH2O, respiratory rate 10 rpm, inspiratory time 3.0, positive end-expiratory pressure 30 cmH2O and FI0(2) 100%, for two minutes. After the alveolar recruitment maneuver, the patient presented clinical pulmonary improvement, but there was a variation of 185 to 322 of Pa0(2)/FiO2 (arterial partial pressure of oxygen/ fraction of inspired oxygen). He was discharged from the intensive care unit 22 days after admission. The alveolar recruitment maneuver in this patient showed significant results in the treatment of pulmonary contusion, improving blood oxygenation, preventing alveolar collapse and reversing atelectasis.
- ItemAcesso aberto (Open Access)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.