[Home mechanical ventilation]. / Domowa wentylacja mechaniczna pluc.

BACKGROUND: Home care provided by the Lódz Hospice for Children increases the patients' feeling of security and improves their quality of life. METHODS: The program provides free, around-the-clock, holistic care within a radius of 120 km, in cooperation with the University Hospital. The model of care has been based on the WHO program of home hospitalization. RESULTS: Between 1999 and 2006, 34 paediatric and adult patients, of both sexes (20.6% females, 79.4% males), aged 8 months to 48 years, received home mechanical lungs ventilation. The underlying causes of respiratory failure were neuromuscular pathologies (82.4%), central nervous system disorders (14.7%) and kyphoscoliosis (2.9%). Nineteen (55.9%) patients were children. Seven patients (20.6%) were ventilated invasively, and 27(79.4%), including three infants with spinal muscular atrophy, were ventilated noninvasively. Home lungs ventilation was provided for from 7 to 3089 days. Eight (23.5%) patients, four from each group (invasive vs noninvasive ventilation), died--five in a hospital and three at home. The causes of death were respiratory accident (2) or acute respiratory infection (6). CONCLUSIONS: Our seven-year experience proves that home ventilation can be accepted by patients and their families and can be provided even in infancy. The presented model of care was highly valued by patients.

[Acute respiratory failure in a 16-yr-old girl with alveolar soft part sarcoma]. / Problemy diagnostyczne i terapeutyczne ostrej niewydolnosci oddechowej u 16-letniej dziewczynki z miesakiem tkanek miqkkich.

BACKGROUND: Intensive treatment in oncology often leads to severe complications, including infection and coagulation disturbances. Among the most serious are fungal infections which are often life-threatening, and difficult to recognize and treat. We present a patient with severe pneumonia and pleural effusion, that developed during treatment of a soft tissue sarcoma with pulmonary metastases. CASE REPORT: A 16-year-old girl was admitted to the ITU because of marked dyspnoea, bilateral pneumonia and pleural effusion. She was intubated and placed on a ventilator, and bilateral pleural drains were inserted. She also required vigorous inotropic support (dopamine + noradrenaline). CRP was 12.5-19.8 mg dL(-1) and procalcitonin was below 1 ng mL(-1)). Lung metastases and tuberculosis were excluded and fungal infection suspected. Aspergillus DNA was detected in bronchoalveolar lavage, and in blood serum (PCR). Amphotericin B and voriconazole were instituted, but without evident success, The girl was severely distressed, required mechanical ventilation with an F1O2 of 0.6, while her CRP increased to 28.4 mg dL(-1). The amphotericin was stopped and replaced with caspofungin, resulting in rapid improvement in her clinical status. The girl was extubated after 21 days of ventilation, however due to a very severe opioid withdrawal syndrome with extreme agitation, she was re-intubated. After a further two weeks on methadone and sedatives, she was extubated again, this time successfully, One month later she was discharged from the hospital, still on oral voriconazole. CONCLUSION: Fungal infection should always be considered in immunocompromised patients with clinical signs of systemic infection. Recognition and treatment of pulmonary aspergillosis is difficult and may require multi drug therapy.