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1.
Rev. bras. ter. intensiva ; 33(2): 320-324, abr.-jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1289080

ABSTRACT

RESUMO Apresentação de um caso de infecção por Influenza B e doença de Kawasaki em adolescente ocorrido durante a pandemia da COVID-19. Adolescente asmática evoluiu com febre e síndrome gripal por 7 dias e deu entrada com quadro de insuficiência respiratória aguda, necessitando de intubação orotraqueal. Evoluiu também com instabilidade hemodinâmica respondedora ao uso de droga vasoativa. Foram introduzidas antibioticoterapia e medidas de suporte. Apresentou melhora hemodinâmica e respiratória progressiva, porém mantinha febre e alteração de provas inflamatórias. Durante internação, evoluiu com conjuntivite não purulenta bilateral, descamação de mão e pés, língua em framboesa e linfonodomegalia cervical, recebendo diagnóstico de doença de Kawasaki. Recebeu gamaglobulina e, por conta de quadro clínico refratário, foi administrado também corticoide, evoluindo afebril 24 horas após. Não apresentou alterações coronarianas. O único agente isolado foi Influenza B, mesmo realizando painel viral e investigação para COVID-19 com reação em cadeia da polimerase e sorologia. Durante internação, apresentou tromboembolismo pulmonar, e, em investigação de coagulopatias, foi diagnosticada com mutação em heterozigose de fator V de Leiden. Há uma potencial associação entre doença de Kawasaki e infecção por Influenza B ou outros vírus, como o coronavírus e, por isso, esses diagnósticos devem ser investigados nos pacientes pediátricos, incluindo adolescentes, com quadros febris prolongados.


ABSTRACT We report a case of Influenza B infection and Kawasaki disease in an adolescent, diagnosed during the COVID-19 pandemic. An asthmatic female adolescent presented with fever and flu-like symptoms for 7 days and was admitted with acute respiratory failure requiring mechanical ventilation. She progressed with hemodynamic instability responsive to vasoactive drugs. Antibiotic therapy and support measures were introduced, showing progressive hemodynamics and respiratory improvement, however with persistent fever and increased inflammatory markers. During the hospitalization, she developed bilateral non-purulent conjunctivitis, hand and feet desquamation, strawberry tongue, and cervical adenopathy, and was diagnosed with Kawasaki disease. She was prescribed intravenous immunoglobulin and, due to the refractory clinical conditions, corticosteroid therapy was added; 24 hours later, the patient was afebrile. No coronary changes were found. A full viral panel including COVID-19 C-reactive protein and serology could only isolate the Influenza B virus. During the hospitalization, she was diagnosed with pulmonary thromboembolism; coagulopathies were investigated, and she was diagnosed with heterozygous factor V Leiden mutation. There is a potential association between Kawasaki disease and infection with Influenza B or with other viruses such as coronavirus. Therefore, this association should be considered in pediatric patients, adolescents included, with prolonged febrile conditions.


Subject(s)
Humans , Female , Adolescent , Respiratory Insufficiency/diagnosis , Influenza, Human/diagnosis , COVID-19 , Mucocutaneous Lymph Node Syndrome/diagnosis , Influenza B virus/isolation & purification , Respiration, Artificial , Respiratory Insufficiency/etiology , Influenza, Human/therapy , Hospitalization , Mucocutaneous Lymph Node Syndrome/complications
3.
Rev. bras. ter. intensiva ; 33(1): 75-81, jan.-mar. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1289055

ABSTRACT

RESUMO Objetivo: Detectar precocemente a instabilidade respiratória e hemodinâmica para caracterizar o comprometimento pulmonar em pacientes com COVID-19 grave. Métodos: Analisamos retrospectivamente os dados colhidos de pacientes com COVID-19 que apresentaram insuficiência respiratória aguda com necessidade de intubação e ventilação mecânica. Utilizamos a avaliação da termodiluição transpulmonar por meio do dispositivo PiCCO™. Foram coletados os dados demográficos, respiratórios, hemodinâmicos e ecocardiográficos dentro das primeiras 48 horas após a admissão. Para resumir os dados, utilizamos estatística descritiva. Resultados: Entre 22 de março e 7 de abril de 2020, foram admitidos 23 pacientes com COVID-19 grave. Foram monitorados com o dispositivo PiCCO™ 12 (22,6%) deles. Quando da admissão, o volume diastólico final global indexado era normal (média de 738,8mL ± 209,2) e, na hora 48, encontrava-se moderadamente aumentado (879mL ± 179), enquanto o índice cardíaco se achava abaixo do normal (2,84 ± 0,65). Todos os pacientes revelaram a presença de água extravascular pulmonar acima de 8mL/kg na admissão (17,9 ± 8,9). Não identificamos qualquer evidência de origem cardiogênica. Conclusão: No caso de pneumonia grave por COVID-19, o quadro hemodinâmico e respiratório é compatível com edema pulmonar sem evidência de origem cardiogênica, o que favorece o diagnóstico de síndrome do desconforto respiratório agudo.


ABSTRACT Objective: To detect early respiratory and hemodynamic instability to characterize pulmonary impairment in patients with severe COVID-19. Methods: We retrospectively analyzed data collected from COVID-19 patients suffering from acute respiratory failure requiring intubation and mechanical ventilation. We used transpulmonary thermodilution assessment with a PiCCO™ device. We collected demographic, respiratory, hemodynamic and echocardiographic data within the first 48 hours after admission. Descriptive statistics were used to summarize the data. Results: Fifty-three patients with severe COVID-19 were admitted between March 22nd and April 7th. Twelve of them (22.6%) were monitored with a PiCCO™ device. Upon admission, the global-end diastolic volume indexed was normal (mean 738.8mL ± 209.2) and moderately increased at H48 (879mL ± 179), and the cardiac index was subnormal (2.84 ± 0.65). All patients showed extravascular lung water over 8mL/kg on admission (17.9 ± 8.9). We did not identify any argument for cardiogenic failure. Conclusion: In the case of severe COVID-19 pneumonia, hemodynamic and respiratory presentation is consistent with pulmonary edema without evidence of cardiogenic origin, favoring the diagnosis of acute respiratory distress syndrome.


Subject(s)
Humans , Male , Female , Middle Aged , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/diagnosis , COVID-19/complications , Patient Discharge , Pulmonary Edema/diagnosis , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Thermodilution/instrumentation , Thermodilution/methods , Time Factors , Acute Disease , Retrospective Studies , Positive-Pressure Respiration, Intrinsic , COVID-19/blood
5.
Autops. Case Rep ; 11: e2021266, 2021. graf
Article in English | LILACS | ID: biblio-1249032

ABSTRACT

Hydrogen chloride is available commercially as an anhydrous gas or an aqueous solution, hydrochloric acid. Exposure to this gas has been associated with the development of reactive airways dysfunction syndrome. However, there are few published reports. A 37-year-old woman developed progressive bronchospasm and acute respiratory failure after cleaning an enclosed space with an unknown concentration of hydrochloric acid gas from a cleaning substance. She had no prior history of asthma or atopy. Severe bronchospasm developed, leading to hypoxemia and diffuse interstitial infiltrates, necessitating orotracheal intubation and admission to the intensive care unit. Asthma-like symptoms such as cough, wheezing, and dyspnea; requiring bronchodilators, and repeated hospitalizations are persistent a year after the accident. Pulmonary function testing showed mild airflow obstruction.


Subject(s)
Humans , Female , Adult , Respiratory Distress Syndrome, Newborn/complications , Respiratory Insufficiency/etiology , Hydrochloric Acid/adverse effects , Inhalation , Bronchial Hyperreactivity/complications
8.
Neumol. pediátr. (En línea) ; 15(1): 245-250, Mar. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1088089

ABSTRACT

The severe respiratory insufficiency (SRI) caused by acute bronchitis whose main etiology is the respiratory syncytial virus is the main cause of under 2-year-old children hospitalization during the winter months, especially in the risk groups. Its treatment is mainly based in general measures, administration of respiratory support with standard oxygen therapy, non-invasive ventilation, invasive mechanical ventilation or the emerging high flow nasal cannula therapy, which these past few years has become an easy alternative of use, well tolerated, secure to be used in emergency rooms, basic rooms and pediatric intensive care units. The election of therapy will depend of the patient severity, the level of complexity of the healthcare center and the experience in the different treatment modalities of the health team. It is essential to carry out protocols and guidelines for the management of SRI treatment caused by acute bronchitis for emergency services, basic rooms and pediatric intensive care.


La insuficiencia respiratoria aguda (IRA) causada por bronquiolitis aguda (BA), cuya principal etiología es el virus respiratorio sincicial (VRS), es la principal causa de hospitalizaciones en menores de 2 años durante los meses de invierno, especialmente en grupos de riesgo. Su manejo se basa principalmente en medidas generales, administración de soporte respiratorio con oxigenoterapia estándar, ventilación no invasiva (VNI), ventilación mecánica invasiva (VMI) o la emergente terapia con cánula nasal de alto flujo (CNAF), que se ha transformado en los últimos años en una alternativa de fácil uso, bien tolerada, segura para ser usada en los servicios de urgencia, salas básicas y unidades de cuidados intensivos pediátricos (UCIP). La elección de la terapia a utilizar dependerá de la gravedad del paciente, del nivel de complejidad del centro asistencial y de la experiencia en las distintas modalidades de tratamiento del equipo de salud. Es fundamental realizar protocolos y guías de manejo de tratamiento de la IRA causada por BA tanto para servicios de urgencia, salas básicas como cuidados intensivos pediátricos.


Subject(s)
Humans , Infant, Newborn , Infant , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Oxygen Inhalation Therapy , Respiration, Artificial/methods , Bronchiolitis, Viral/complications , Respiratory Syncytial Virus Infections/complications , Cannula
10.
Rev. Col. Bras. Cir ; 47: e20202510, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136560

ABSTRACT

ABSTRACT Introduction: percutaneous dilatational tracheostomy is currently one of the main procedures performed in an intensive care unit (ICU). However, there are no well-defined indicators of technical difficulty in performing the procedure. Objectives: to define predictors of difficulty in performing bedside percutaneous dilatational tracheostomy. Methodology: prospective cohort study encompassing 21 patients who underwent bedside percutaneous dilatational tracheostomy in the ICU at a single center. Results: Sternohyoid (SH) distance shorter than 7 cm is associated with a 50% increase in the risk of technical difficulty (OR 0.44 and p <0.03). Conclusion: the reduction in (SH) distance is related to an increased risk of difficulty in performing percutaneous dilatational tracheostomy in the ICU bed.


RESUMO Introdução: a traqueostomia percutânea é hoje um dos principais procedimentos realizados em unidade de terapia intensiva (UTI). Não há, contudo, indicadores bem definidos de dificuldade técnica na realização do procedimento. Objetivos: definir preditores de dificuldade para realização de traqueostomia percutânea. Metodologia: estudo de coorte prospectivo no qual foram incluídos 21 pacientes submetidos a traqueostomia percutânea à beira leito, na UTI, em um único centro. Resultados: distância EH menor que 7 cm está associada a aumento de 50% na chance de dificuldade técnica (OR 0,44 e p<0,03). Conclusão: a redução da distância EH está relacionada com aumento do risco de dificuldade em realizar a traqueostomia percutânea à beira do leito, em UTI.


Subject(s)
Humans , Respiratory Insufficiency/therapy , Tracheostomy/methods , Respiratory Insufficiency/etiology , Tracheostomy/adverse effects , Pilot Projects , Prospective Studies , Dilatation/adverse effects , Dilatation/methods , Intensive Care Units
11.
In. Verga, Federico; Burghi, Gastón. Encares de paciente crítico. Montevideo, Oficina del Libro FEFMUR, 2020. p.177-191.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1342647
13.
Autops. Case Rep ; 9(4): e2019119, Oct.-Dec. 2019. ilus
Article in English | LILACS | ID: biblio-1024159

ABSTRACT

Congenital acinar dysplasia is a lethal, developmental lung malformation resulting in neonatal respiratory insufficiency. This entity is characterized by pulmonary hypoplasia and arrest in the pseudoglandular stage of development, resulting in the absence of functional gas exchange. The etiology is unknown, but a relationship with the disruption of the TBX4-FGF10 pathway has been described. There are no definitive antenatal diagnostic tests. It is a diagnosis of exclusion from other diffuse embryologic lung abnormalities with identical clinical presentations that are, however, histopathologically distinct.


Subject(s)
Humans , Female , Infant, Newborn , Respiratory Insufficiency/etiology , Lung/abnormalities , Lung Diseases/congenital , Autopsy , Fatal Outcome , Lung/pathology
14.
Rev. chil. pediatr ; 90(6): 657-661, dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058197

ABSTRACT

INTRODUCCIÓN: La Neumonía Eosinofílica (NE) es una entidad muy poco frecuente en pediatría y se caracteriza por infiltración de eosinófilos en el intersticio pulmonar y alveolar, pudiendo ser primaria o secundaria, así como también presentar un curso agudo o crónico. OBJETIVO: Presentar dos casos clínicos de NE diagnosticados en el período 2014-2017 en una Unidad de Cuidados Intensivos pediátricos. CASOS CLÍNICOS: Dos lactantes mayores, ambos con antecedente de madre asmática, hospitalizados por in suficiencia respiratoria y diagnóstico de neumonía viral en Clínica Indisa, Santiago, Chile. Ambos presentaron síndrome febril, imágenes de condensación persistentes en la radiografía de tórax y eosinofilia periférica en el transcurso de su enfermedad. Uno de ellos con requerimiento de oxígeno por más de un mes, sin eosinofilia en el lavado broncoalveolar (LBA), al que se le hizo el diagnóstico de NE por biopsia pulmonar. El otro niño requirió ventilación mecánica por 28 días y se hizo diag nóstico de NE por eosinofilia mayor a 20% en LBA. Los dos casos presentaron excelente respuesta a corticoides sistémicos. CONCLUSIÓN: La NE se debe sospechar en el niño con diagnóstico de neumonía con síntomas persistentes sin respuesta al tratamiento, habiéndose descartado otras causas, sobre todo si se asocia a eosinofilia periférica. El diagnostico de NE en pediatría se confirma por eosinofilia mayor a 20% en LBA y en algunos casos es necesaria la biopsia pulmonar.


INTRODUCTION: Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE: to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES: Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION: After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.


Subject(s)
Humans , Male , Infant , Pulmonary Eosinophilia/diagnosis , Oxygen/therapeutic use , Pneumonia, Viral/diagnosis , Pulmonary Eosinophilia/pathology , Pulmonary Eosinophilia/diagnostic imaging , Respiration, Artificial , Respiratory Insufficiency/etiology , Biopsy , Bronchoalveolar Lavage , Lung/pathology
15.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 234-240, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013290

ABSTRACT

ABSTRACT Objective: To evaluate exercise capacity in children and adolescents with post-infectious bronchiolitis obliterans. Data source: This is a systematic review based on data from PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), and Physiotherapy Evidence Database (PEDro). We used the following search strategy: "Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six-minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans." We selected studies that evaluated exercise capacity through maximal/submaximal testing in children and adolescents with post-infectious bronchiolitis obliterans, and no other associated disease. We searched articles in English, Portuguese, and Spanish, without restrictions regarding the period of publication. The methodological quality was assessed by the Agency for Healthcare Research and Quality (AHRQ) protocol. Data synthesis: Out of the 81 articles found, only 4 were included in this review. The studies totaled 135 participants (121 with post-infectious bronchiolitis obliterans and 14 healthy), with sample sizes between 14 and 58 subjects. All patients underwent spirometry to evaluate pulmonary function, indicating an obstructive ventilatory pattern. Among them, 3/4 had their physical performance assessed by the six-minute walk test and 2/4 by the cardiopulmonary exercise testing. These test results were compared to those of a control group (1/4) and presented as percentage of predicted and/or in meters (3/4). Lastly, 3/4 of the studies showed reduced exercise capacity in this population. The studies included were classified as having high methodological quality. Conclusions: Findings of the study demonstrate that children and adolescents with post-infectious bronchiolitis obliterans have reduced exercise capacity.


RESUMO Objetivo: Avaliar a capacidade de exercício em crianças e adolescentes com bronquiolite obliterante pós-infeciosa. Fonte de dados: Trata-se de uma revisão sistemática por meio das bases de dados PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e Physiotherapy Evidence Database (PEDro). Utilizou-se a seguinte estratégia de busca: "Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans". Foram selecionados estudos que avaliaram a capacidade de exercício por meio de testes máximos/submáximos em crianças e adolescentes com bronquiolite obliterante pós-infeciosa, sem qualquer outra doença associada. Buscaram-se artigos nos idiomas inglês, português e espanhol e sem restrições quanto ao período de publicação. A qualidade metodológica foi avaliada pelo protocolo da Agency for Health Care Research and Quality (AHRQ). Síntese dos dados: De um total de 81 artigos, apenas 4 foram incluídos nesta revisão. Os estudos totalizaram 135 participantes (121 com bronquiolite obliterante pós-infeciosa e 14 saudáveis), com tamanho amostral entre 14 e 58 sujeitos. Todos avaliaram a função pulmonar por meio da espirometria, observando um padrão ventilatório obstrutivo. Desses, 3/4 avaliaram o desempenho físico pelo teste de caminhada de seis minutos e 2/4 pelo teste de exercício cardiopulmonar. Os resultados desses testes foram comparados a um grupo controle (1/4), bem como apresentados em percentual do previsto e/ou em metros (3/4). Por fim, 3/4 dos estudos demostraram que a capacidade de exercício se encontra reduzida nessa população. Os estudos incluídos foram classificados com alta qualidade metodológica. Conclusões: Os achados do estudo demonstram que crianças e adolescentes com bronquiolite obliterante pós-infeciosa apresentam redução da capacidade de exercício.


Subject(s)
Humans , Child , Adolescent , Bronchiolitis Obliterans/complications , Exercise Tolerance , Respiratory Function Tests/methods , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology
16.
Medisan ; 23(1)ene.-feb. 2019. ilus
Article in Spanish | LILACS | ID: biblio-990181

ABSTRACT

Se presenta el caso clínico de un niño de un año de edad, quien fue atendido en el Servicio de Pediatría del Hospital de Serrekunda en Gambia por presentar, desde hacía 2 días, dificultad respiratoria, tos y falta de aire, todo ello de inicio rápido. Ante la posible presencia de un cuerpo extraño en las vías respiratorias altas se realizó un examen físico minucioso que incluyó el laringoscopio, pero debido a su ubicación profunda no fue posible una correcta observación de este, por lo cual se indicaron otros estudios (resonancia magnética y endoscopia), que permitieron una correcta visualización de dicho cuerpo. Debido al tratamiento multidisciplinario y oportuno, el paciente tuvo una evolución favorable y egresó sin complicaciones.


The case report of a year-old child is presented who was assisted in the Pediatrics Service of the Serrekunda Hospital in Gambia for presenting breathing difficulty for 2 days, cough and lack of air, all of them of fast beginning. Taking into account the possible presence of a strange body in the high breathing ways a meticulous physical exam was carried out that included the laryngoscope, but due to its deep location it was not possible a correct observation of it, reason why other studies were indicated (magnetic resonance and endoscopy) that allowed a correct visualization of this body. Due to the multidisciplinary and opportune treatment, the patient had a favorable clinical course and was discharged without complications.


Subject(s)
Humans , Male , Infant , Respiratory Insufficiency/etiology , Foreign-Body Reaction , Foreign Bodies/diagnosis , Emergencies , Emergency Medical Services
17.
The Egyptian Journal of Hospital Medicine ; 75(3): 2426-2432, 2019. tab
Article in English | AIM, AIM | ID: biblio-1272758

ABSTRACT

Background: Removal of patients from mechanical ventilation (MV) has been termed liberation, discontinuation, withdrawal and most commonly weaning. Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Although weaning from MV is successful in most cases, the first attempt fails in 20% of patients. In addition, weaning accounts for over 40% of the total MV time, the proportion varying in function of the etiology of respiratory failure. Objective: The aim of this study was to evaluate the recent protocols of successful weaning from mechanical ventilation of critically ill patients, depending on central venous oxygen saturation, ultrasonographic assessment of diaphragmatic movement, and serial arterial blood gases to assess failure rate 48 hours after weaning. Patients and methods: This prospective randomized study included a total of 90 mechanically ventilated Egyptian patients of both sexes, ASA (I-II) attending at least for 48 hours at intensive care unit, AlAzhar University Hospitals. The included subjects were divided into three groups depending on method of monitoring; group A: serial arterial blood gases, group B: Central venous oxygen saturation and group C: Ultrasonographic assessment of diaphragmatic movement pre and post spontaneous breathing trial. All patients were subjected to daily monitoring of the following weaning parameters: static and dynamic compliances and inspiratory resistance, intrinsic positive end expiratory pressure (Auto PEEP) and Maximum inspiratory pressure (MIP). Results: There is highly statistically significant difference between patients as regard weaning outcome. As the group depended on normal ultrasonographic assessment of diaphragmatic movement, had the largest number of patients with successful weaning. Conclusion: Normal ultrasonographic assessment of diaphragmatic movement proved to be the most important criteria for successful weaning from mechanical ventilation


Subject(s)
Critical Illness , Echocardiography , Egypt , Respiration, Artificial/therapeutic use , Respiratory Insufficiency/etiology , Ventilator Weaning/economics
18.
Medisan ; 22(9)nov.-dic. 2018. tab
Article in Spanish | LILACS | ID: biblio-976166

ABSTRACT

Se realizó una investigación descriptiva, de serie de casos, de 31 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero de 2014 a igual mes de 2017, quienes presentaron el síndrome de insuficiencia respiratoria aguda, con vistas a describir los factores pronóstico de mortalidad por esta causa. En la serie predominaron el sexo masculino, la edad promedio de 57 años y la hipertensión arterial como enfermedad crónica asociada. La mayoría de los pacientes recibía ventilación mecánica previa al diagnóstico, en la modalidad controlada por volumen, y en un menor número se aplicaron maniobras de incorporación alveolar. La insuficiencia respiratoria moderada de causa extrapulmonar figuró en pacientes con ventilación prolongada, en tanto la complicación más frecuente fue la disfunción multiorgánica, que además resultó la principal causa de muerte. Finalmente, no se encontró relación directa entre la presencia de estos factores pronóstico de mortalidad y la probabilidad de fallecer.


A descriptive investigation, of cases series, in 31 patients admitted in the Intensive Care Unit of Saturnino Lora Torres Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2014 to same month in 2017, who presented acute respiratory failure, with the aim of describing the mortality prognosis factors for this cause. In the series the male sex, the average age 57 year-old and hypertension prevailed as associated chronic diseases. Most of the patients received mechanic ventilation previous to the diagnosis, in the modality controlled through volume, and in a lower number maneuvers of alveolar incorporation were applied. The moderate respiratory failure of extrapulmonar cause was present in patients with prolonged ventilation, as long as the most frequent complication was the multiple organs dysfunction which was also the main cause of death. Finally, there was no direct relationship between the presence of these mortality factors prognosis and the probability of dying.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Prognosis , Respiration, Artificial , Respiratory Insufficiency/etiology , Critical Care/methods , Respiratory Insufficiency/complications , Respiratory Insufficiency/mortality
19.
Neumol. pediátr. (En línea) ; 13(4): 164-167, oct. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-947865

ABSTRACT

Stevens-Johnson syndrome corresponds to a hypersensitivity reaction produced by various etiologies, for example exposure to drugs, microbial agents, or by an idiopathic cause. It is marked by an acute vesicular-bullous eruption, which affects the skin and mucous membranes, with systemic manifestations of variable severity, and it may present a fatal evolution. Stevens-Johnson syndrome can occasionally present chronic pulmonary complications, such as bronchiolitis obliterans; however, other etiologies are more frequent in our environment, for example severe pneumonia due to adenovirus. Our objective is to present two cases of bronchiolitis obliterans post Stevens-Johnson syndrome and to make a literature review.


El síndrome de Stevens-Johnson corresponde a una respuesta de hipersensibilidad producida por diversas etiologías, que incluyen exposición a drogas, agentes microbianos o idiopática. Se manifiesta por una erupción vesículo-bulosa aguda, que afecta la piel y las mucosas, con manifestaciones sistémicas de severidad variable, pudiendo presentar una evolución fatal. El síndrome de Stevens-Johnson puede presentar ocasionalmente complicaciones pulmonares crónicas, como bronquiolitis obliterante, siendo en nuestro medio más frecuente otras etiologías, como la observada luego de una neumonía grave por adenovirus. El objetivo es presentar dos casos de bronquiolitis obliterante post síndrome de Stevens-Johnson y hacer una revisión de la literatura.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Respiratory Insufficiency/etiology , Bronchiolitis Obliterans/etiology , Bronchiolitis Obliterans/pathology , Stevens-Johnson Syndrome/complications , Respiratory Insufficiency/pathology , Spirometry , Bronchiolitis Obliterans/diagnostic imaging , Radiography, Thoracic , Maximal Expiratory Flow-Volume Curves
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