ABSTRACT
The development of acute respiratory failure (ARF) in patients with hematologic disorders (HDs) is a life-threatening condition which does not respond well to intensive therapy. We present our experience in the use of intensive therapy for a group of 30 patients suffering from leukemia (21 cases), bone-marrow aplasia (6 cases), or lymphoma (3 cases). Seven had undergone bone-marrow transplantation. All 30 patients were hypoxemic and responded poorly to the administration of high oxygen concentrations via face mask. All were admitted to our intensive respiratory unit (IRU), where 26 received oxygen via mechanical ventilation, and 4 received continuous positive airway pressure (CPAP). Definitive diagnosis was established in 19 (63%) patients. A premortem diagnosis obtained in 8 (26%) cases did not change therapy. The diagnostic accuracy of serology and transbronchial biopsy was low. Of the 6 (20%) patients who recovered from ARF, only 2 were discharged from the hospital. The remaining 24 (80%) patients died in the IRU.
Subject(s)
Anemia, Aplastic/complications , Critical Care , Leukemia/complications , Lymphoma/complications , Oxygen/blood , Respiratory Insufficiency/complications , Adolescent , Adult , Aged , Anemia, Aplastic/physiopathology , Anemia, Aplastic/therapy , Child , Female , Humans , Leukemia/physiopathology , Leukemia/therapy , Lymphoma/physiopathology , Lymphoma/therapy , Male , Middle Aged , Oxygen/therapeutic use , Respiration, Artificial , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Retrospective StudiesABSTRACT
The purpose of this study was to assess the incidence, evolution and long-term effects of laryngotracheal lesions due to endotracheal intubation and to evaluate the import of factors in the genesis of laryngotracheal injury. Over a 12-month period, we performed fiberoptic bronchoscopy (FBS) in 19 critically ill patients with endotracheal intubation. Early laryngeal lesions, mainly true vocal cord granulomas and ulceration, appeared in 12 (63%) patients and were resolved by the 3rd month in all but 3 patients. In 6 (31%) patients, early tracheal lesions appeared in the form of ring-shaped tracheitis at the cuff level and granulomas at the tube-tip level; in 2 (10%) patients, an established tracheal stenosis developed and early detected ring-shaped tracheitis preceded circumferential fibrous stenosis. Severe respiratory failure, high cuff pressure, and secretion infection showed a statistical correlation to tracheal injury.
Subject(s)
Intubation, Intratracheal/adverse effects , Laryngeal Diseases/etiology , Tracheal Diseases/etiology , Adult , Aged , Critical Care , Female , Humans , Lung Diseases/therapy , Male , Middle Aged , Prospective Studies , Time FactorsABSTRACT
Four cases of acute life-threatening tracheal obstruction due to intrathoracic goiter are reported. Acute respiratory insufficiency caused by an upper airway obstruction in patients with intrathoracic goiter is exceptional. In 3 of 4 cases reported, the histologic study showed multiple foci of recent hemorrhage, the mechanism probably responsible for these episodes.
