Imágenes Doppler de arterias intrapulmonares dentro de la atelectasia y su impacto en la poscarga del ventrículo derecho con ecocardiografía transesofágica / Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography

La cirugía cardíaca por toracoscopia videoasistida (VATS) requiere ventilación unipulmonar (VUP) y monitorización con ecografía transesofágica (ETE). Utilizando Doppler color y espectral es posible estudiar el patrón de flujo sanguíneo en los vasos pulmonares dentro del pulmón atelectasiado. El objetivo de este reporte de casos es evidenciar la habilidad de la ETE para detectar el flujo sanguíneo dentro del pulmón atelectásico, así como también valorar la resistencia vascular pulmonar (RVP) y poscarga del ventrículo derecho, utilizando esta misma herramienta. Hallazgos: Tres adultos anestesiados y ventilados mecánicamente programados para cirugía cardíaca por VATS fueron escaneados con ETE cardiopulmonar. Una vez que se realizó la VUP quedando el pulmón derecho sin ventilar, la sonda se giró desde el corazón para lograr un escaneo pulmonar 2D y con Doppler color para detectar el flujo de sangre dentro del parénquima pulmonar consolidado. Se pudo identificar el patrón de flujo correspondiente a las ramas de la arteria intrapulmonar. La RVP fue registrada aplicando Doppler pulsado cardíaco, basal luego de la inducción de anestesia general, a los 20min de la VUP y al finalizar la VUP, luego de realizar una maniobra de reclutamiento alveolar (MRA) que condujo a la resolución completa de la consolidación mencionada. Conclusiones: La ETE cardiopulmonar es una herramienta de imagen semiinvasiva que permite no solo el diagnóstico y estudio de atelectasias inducidas por VUP, sino también el análisis del shunt dentro de esta consolidación y sus posibles consecuencias en la RVP.(AU)

Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular afterload. Findings: Three anaesthetised, mechanically ventilated adults scheduled for VATS cardiac surgery were monitored using TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. Conclusions: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.(AU)

Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography.

Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular (RV) afterload. FINDINGS: Three anaesthetised, mechanically ventilated adults scheduled for cardiac surgery by VATS were scanned with TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20 min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. CONCLUSIONS: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.

Comparación de 3 modos de ventilación mecánica en colecistectomía laparoscópica / Comparison of 3 mechanical ventilation modes in laparoscopic cholecystectomy

Resumen: El modo ventilatorio asistido durante un procedimiento laparoscópico aún es controversial. Objetivo: Comparar la dinámica ventilatoria según el modo de ventilación asistida: por ventilación controlada por volumen (VCV), controlada por presión (VCP) o por presión con garantía de volumen (VCP-GV), en anestesia para colecistectomía laparoscópica. Material y métodos: 21 pacientes adultos manejados con una de las tres modalidades (7 por grupo). Se analizó durante el procedimiento (a la intubación, la insuflación de CO2 intraabdominal y resolución), su frecuencia respiratoria, el volumen espiratorio, CO2 al final de la espiración (EtCO2), presión pico vía aérea, presión media pulmonar, distensibilidad, saturación de oxígeno y volumen minuto respiratorio. Resultados: Posterior a la intubación, no hubo diferencias clínicas importantes en las mediciones entre los modos de ventilación. A la insuflación los pacientes con modo VCP incrementaron su frecuencia respiratoria, pero conservaron su presión pico; contra aquéllos en modo VCV y VCP-GV que incrementaron su presión pico con escasa reducción de su frecuencia respiratoria. Las otras variables no se modificaron durante el procedimiento y no hubo diferencias entre los modos ventilatorios. Conclusión: Los tres modos de ventilación permitieron un buen control ventilatorio con pocas diferencias respecto a parámetros basales, pero sugerimos que el modo VCP previene mejor los aumentos en la presión pico.

Abstract: The assisted ventilatory mode during a laparoscopic procedure is still controversial. Objective: To compare ventilatory dynamics according to the assisted ventilation mode: by volume-controlled ventilation (VCV), pressure-controlled (PCV) or by pressure with volume guarantee (PVC-VG), in general anesthesia for laparoscopic cholecystectomy. Material and methods: 21 adult patients managed with one of the three modalities (seven per group). Their respiratory rate, minute expiratory volume, end tidal CO2 (EtCO2), peak airway pressure, mean pulmonary pressure, compliance, oxygen saturation and minute respiratory volume were analyzed during the procedure (at intubation, abdominal CO2 insufflation and resolution). Results: After intubation there were no clinical differences in measurements between ventilation modes. On insufflation, patients with PCV mode increased their respiratory rate, but kept their peak pressure; against those in VCV and PCV-VG mode who increased their peak pressure with little reduction in their respiratory rate. The other variables were not modified during the procedure and there were no differences between the ventilatory modes. Conclusion: The three modes of ventilation allowed a good ventilatory control, but we suggest the PCV since it prevents an increase in peak pressure.

Original and minimally invasive approach to a left-lung refractory atelectasis after reparation of an aortic recoarctation in a lactant: Selective endobronchial CPAP.

Atelectasis is one of the most common respiratory complications in pediatric patients after open-heart surgery, and may lead to weaning failure and increased morbidity. We report the use of an original, minimally invasive approach to refractory left lung atelectasis after repair of an aortic coarctation in a 2 month-old infant, in which a CPAP system connected to a flexible endobronchial tube resolved the atelectasis.

Complicações respiratórias secundárias a lesões inalatórias em indivíduos queimados e atuação fisioterapêutica: Uma revisão de literatura / Respiratory complications in inhalation injury in burnt individuals and physiotherapy action: A literature review / Complicaciones respiratorias secundarias a lesiones inalatórias en individuos quemados y actuación de la fisioterapia: Una revisión de literatura

OBJETIVO: Identificar as principais complicações respiratórias em pacientes queimados associadas à lesão inalatória (LI) e às condutas fisioterapêuticas empregadas com esses pacientes. MÉTODO: Foi realizada uma revisão de literatura nas bases de dados LILACS, Scielo e PubMed, e o período de publicação dos artigos foi delimitado entre 2008 e 2018. RESULTADOS: Dentre os sinais e características mais comuns em casos de LI, encontram-se escarro, tosse, falta de ar e dispneia. Os menos comuns são chiado, rouquidão, fadiga, dor de garganta e alterações do ritmo respiratório. Os achados físicos podem ser confirmados por estudos incluindo broncoscopia de fibra ótica. Quanto ao tratamento instituído, temos o emprego da ventilação mecânica e a intubação. CONCLUSÃO: A realização desse estudo de revisão de literatura evidenciou uma variedade de danos causados à mucosa respiratória em consequência a uma LI. Tais complicações podem ser fatais se não tratadas de forma rápida e eficaz; a fisioterapia respiratória, por meio de suas formas de tratamento e recursos, mostrou ter uma valiosa contribuição para identificação e tratamento das diversas complicações pulmonares causadas pela LI.

OBJECTIVE: To identify the main respiratory complications in burn patients associated with inhalation injury and the physiotherapeutic action with these patients. METHODS: A review of the literature was carried in the LILACS, Scielo and PubMed databases, where the period of publication of articles was delimited between 2008 and 2018. RESULTS: Among the signs and characteristics most common in cases of inhalation injury are sputum, cough, shortness of breath and dyspnea. The least common are wheezing, hoarseness, fatigue, sore throat and changes in breathing rhythm. Physical findings may be confirmed by studies including fiberoptic bronchoscopy. Regarding the treatment instituted, we have the use of mechanical ventilation and intubation. CONCLUSION: The performance of this literature review study revealed a variety of damage to the respiratory mucosa as a consequence of an inhalation injury. Such complications can be fatal if not treated quickly and effectively; respiratory physiotherapy through its forms of treatment and resources, has been shown to have a valuable contribution to the identification and treatment of various pulmonary complications caused by inhalation injury.

Objetivo: Identificar las principales complicaciones respiratorias en pacientes quemados asociados a lesiones inalatórias (LI) y las conductas de la fisioterapia empleadas con esos pacientes. Método: Se realizó una revisión de literatura en las bases de datos LILACS, Scielo y PubMed, en el cual el período de publicación de los artículos fue delimitado entre 2008 y 2018. Resultados: Entre las señales y características más comunes en el caso de LI se encuentran esputo, tos, falta de aire y disnea. Los menos comunes son "chillado", ronquera, fatiga, dolor de garganta y cambios del ritmo respiratorio. Los hallazgos físicos pueden ser confirmados por estudios incluyendo broncoscopia de fibra óptica. En cuanto al tratamiento instituido, tenemos el empleo de la ventilación mecánica y la intubación. Conclusión: La realización de este estudio de revisión de literatura evidenció una variedad de daños causados en la mucosa respiratoria en consecuencia a una LI. Tales complicaciones pueden ser fatales si no se tratan de forma rápida y eficaz; la fisioterapia respiratoria, por medio de sus formas de tratamiento y recursos mostró tener una valiosa contribución para la identificación y tratamiento de las diversas complicaciones pulmonares causadas por la LI.

Recruitment manoeuvres in anaesthesia: How many more excuses are there not to use them? / Maniobras de reclutamiento en anestesia: ¿qué más excusas para no usarlas?

Pulmonary recruitment manoeuvres (RM) are intended to reopen collapsed lung areas. RMs are present in nature as a physiological mechanism to get a newborn to open their lungs for the first time at birth, and we also use them, in our usual anaesthesiological clinical practice, after induction or during general anaesthesia when a patient is desaturated. However, there is much confusion in clinical practice regarding their safety, the best way to perform them, when to do them, in which patients they are indicated, and in those where they are totally contraindicated. There are important differences between RM in the patient with adult respiratory distress syndrome, and in a healthy patient during general anaesthesia. Our intention is to review, from a clinical and practical point of view, the use of RM, specifically in anaesthesia.

Algunos síndromes radiológicos en pediatría / Some radiological syndromes in pediatrics

Las 4 situaciones presentadas son ejemplos de las condensaciones lobares y segmentarias. Habitualmente presentan clínica de neumonía aguda, relacionadas con etiologías bacterianas. Desde el punto de vista de los signos radiológicos presentan imágenes de condensación pulmonar que: Opacifican lóbulos o segmentos,respetando los límites anatómicos. Respetan el volumen o lo aumentan levemente. Mantienen las cisuras en su sitio o las desplazan levemente, generando convexidad. No alteran la situación de los hilios pulmonares. No desplazan el mediastino (AU). Contiene imágenes radiográficas de distintas situaciones clìnicas

[Basic lung ultrasound. Part 2. Parenchymal diseases]. / Ecografía pulmonar básica. Parte 2. Patología parenquimatosa.

In this second part, an analysis is made of the pathology of lung parenchyma. This text is structured into different sections, including the study of atelectasias, pneumonia and abscess, interstitial/alveolar or Blines patterns, and finally an analysis is made of pulmonary embolism. With this second part, the basic knowledge to develop lung ultrasound in the anesthesia department has been presented.

Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation / Efeitos da manobra de compressão e descompressão torácica nos volumes pulmonares, capnografia e oximetria de pulso em pacientes submetidos à ventilação mecânica

OBJECTIVES: The aims of this study were to evaluate whether there are changes in lung volumes, capnography, pulse oximetry and hemodynamic parameters associated with manual chest compression-decompression maneuver (MCCD) in patients undergoing mechanical ventilation (MV). Method: A prospective study of 65 patients undergoing to MV after 24 hours. All patients received bronchial hygiene maneuvers and after 30 minutes they were submitted to ten repetitions of the MCCD during 10 consecutive respiratory cycles in the right hemithorax and than in the left hemithorax. The data were collected before the application of the maneuver and after 1, 5, 10, 15, 20, 25, 30, 35 and 40 minutes following application of the maneuver. RESULTS: There were statistical significant (p<0.0001) improvements in the following parameters after MCCD maneuver during all phases of data collection until 40 minutes: inspiratory tidal volume (baseline: 458.2±132.1 ml; post 1 min: 557.3±139.1; post 40 min: 574.4±151), minute volume (baseline: 7.0±2.7 L/min; post 1 min: 8.7±3.3; post 40 min: 8.8±3.8), and pulse oximetry (baseline: 97.4±2.2%; post 1 min: 97.9±1,8; post 40 min: 98.2±1.6; p<0.05). There was a reduction in CO2 expired (baseline: 35.1±9.0 mmHg; post 1 min: 31.5±8.2; post 40 min: 31.5±8.29; p<0.0001). There was no statically significant changes in heart rate (baseline: 94.5±20.5 mmHg; post 1 min: 94.7±20.5; post 40 min: 94.92±20.20; p=1) and mean arterial pressure (baseline: 91.2±19.1 bpm; post 1 min: 89.5±17.7; post 40 min: 89.01±16.88; p=0.99). The variables were presented in terms of means and standard deviations. CONCLUSION: The MCCD maneuver had positive effects by increasing lung volume and pulse oximetry and reducing CO2 expired, without promoting hemodynamic changes in patients undergoing mechanical ventilation.

OBJETIVOS: Avaliar a presença de alterações nos volumes pulmonares, oximetria de pulso, capnografia e alterações hemodinâmicas associadas à intervenção da manobra de compressão e descompressão torácica (MCDT) nos pacientes submetidos à ventilação mecânica (VM). Método: Tratou-se de um estudo prospectivo em que foram incluídos 65 pacientes em VM há mais de 24 horas. O protocolo consistiu na aplicação de manobras de higiene brônquica e, após 30 minutos, os pacientes eram submetidos a dez repetições da MCDT em dez respirações consecutivas no hemitórax direito e, posteriormente, no hemitórax esquerdo, coletando os dados antes e após a aplicação da manobra nos tempos 1, 5, 10, 15, 20, 25, 30, 35 e 40 minutos. RESULTADOS: Constatou-se aumento significante (p<0,001) do volume corrente inspiratório (pré: 458,2±132,1 ml; pós 1 minuto: 557,3±139,1; pós 40 minutos: 574,4±151), volume minuto corrente (pré: 7,0±2,7 L/min; pós 1 minuto: 8,7±3,3; pós 40 minutos: 8,8±3,8) e oximetria de pulso (pré: 97,4±2,2%; pós 1 minuto: 97,9±1,8; pós 40 minutos: 98,2±1,6; p<0,05). Ocorreu redução no CO2 expirado (pré: 35,1±9,0 mmHg; pós 1 minuto: 31,5±8,2; pós 40 minutos: 31,5±8,29; p<0.0001). Não houve alteração significante da frequência cardíaca (pré: 94,5±20,5 mmHg; pós 1 minuto: 94,7±20,5 e pós 40 minutos: 94,9±20,2; p=1) e pressão arterial média (pré: 91,2±19,1 bpm; pós 1 minuto: 89,5±17,7 e pós 40 minutos: 89,0±16,8; p=0,99). As variáveis foram expressas em média e desvio-padrão. CONCLUSÃO: A MCDT possibilita a otimização dos volumes pulmonares, da oximetria de pulso e a redução do CO2 expirado sem promover alterações hemodinâmicas significantes nos pacientes submetidos à ventilação mecânica.

Radiografía de tórax: un recurso usualmente innecesario para el diagnóstico de la bronquiolitis / Chest X-ray: an unnecessary resource in the diagnosis of acute bronchiolitis

Introducción. La bronquiolitis es una de las enfermedades que más controversia presenta por la variedad en su diagnóstico y manejo en pediatría; los recursos diagnósticos independientes a la clínica son usualmente innecesarios dentro de su presentación clásica. Los objetivos de este trabajo fueron conocer la frecuencia de alteraciones radiográficas significativas en pacientes menores de 24 meses de edad ingresados por el servicio de urgencias con diagnóstico de bronquiolitis y conocer la relación entre los patrones radiológicos y las variables clínicas con objeto de reducir la exposición radiográfica innecesaria. Métodos. Se incluyeron 128 pacientes menores de 24 meses de edad ingresados por el departamento de urgencias del Hospital San José Tec de Monterrey con diagnóstico de bronquiolitis entre septiembre de 2006 y marzo de 2007. Se registraron las siguientes variables clínicas: edad, sexo, días de evolución, saturación de oxígeno, así como las variables de laboratorio: cuenta leucocitaria y linfocitaria e identificación viral respiratoria; también se registró, para cada caso, si se realizaron radiografías de tórax. Resultados. Se obtuvieron las radiografías de tórax de 122 pacientes (95.31 %) y se realizó la investigación del panel viral respiratorio en 119 pacientes (92.96%); de estos 69 fueron positivos (57.99%). El virus sincitial respiratorio estuvo presente en 62 muestras (89.85%). Sólo 15 pacientes (12.29%) presentaron alteraciones significativas como atelectasia/consolidación neumónica en la radiografía de tórax. No hubo diferencias en cuanto a las variables clínicas y de laboratorio en los pacientes con resultados radiológicos normales o anormales. Conclusiones. Las radiografías de tórax no mostraron alteraciones significativas en la mayoría de los pacientes con cuadro de bronquiolitis; nuestro estudio muestra que la radiografía tiene un valor limitado como recurso diagnóstico en la presentación clásica de esta enfermedad.

Background. Bronchiolitis is one of the leading controversial pediatric diseases because of its variations in diagnosis and treatment. Use of diagnostic resources beyond the clinical features is usually unnecessary in its classic presentation. The objective of this study was to evaluate the prevalence of significant abnormalities in radiographic findings performed on infants <24 months of age who were hospitalized through the emergency department with the diagnosis of bronchiolitis, as well as to assess whether clinical variables can accurately identify children with abnormal chest X-ray in order to reduce unnecessary radiation exposure. Methods. From September 2006 to March 2007, infants aged <24 months evaluated and hospitalized through the emergency department of the Hospital San Jose Tec de Monterrey with a diagnosis of bronchiolitis were included in the study. Clinical variables were registered (age, gender, time since onset, oxygen saturation) and laboratory variables as well (leukocytes, lymphocytes, virus identified). Information from the chest X-ray was also obtained. Results. There were 128 patients included; 70% were aged <12 months. Chest X-ray was performed in 122 patients (95.31 %) and respiratory virus studies were done in 119 patients (92.96%). There were 69 patients who were positive (57.99%); respiratory syncytial virus was demonstrated in 62 samples (89.85%) and 15 patients (12.29%) showed abnormal chest X-ray (atelectasis/consolidation). No differences were found between patients with and without chest X-ray abnormalities in clinical and laboratory variables. Conclusions. Most patients with bronchiolitis had a normal chest X-ray. Our study suggests that x-rays in children with typical bronchiolitis have limited value.

Atelectasias em pediatria: mecanismos, diagnóstico e tratamento: [revisão] / Atelectasis: mechanisms, diagnosis and treatment in the pediatric patient: [review]

OBJETIVO: Realizar uma revisão da literatura sobre os mecanismos, diagnóstico e tratamento das atelectasias pulmonares em pediatria. MÉTODOS:Efetuou-se uma pesquisa nos bancos de dados eletrônicos Medline e Scielo com os critérios de inclusão: artigos publicados entre os anos de 1960 e 2007, que abordassem a etiologia, fisiopatologia, conseqüências funcionais, avaliação, prevenção, tratamento e complicações das atelectasias pulmonares em pediatria. Palavras-chave: atelectasis, children, pediatrics, mucus plugs, chest physiotherapy; atelectasias, criança, pediatria, fisioterapia respiratória, secreção brônquica. Utilizou-se o escore de Sackett DL, 1989 para a classificação do nível de evidência dos artigos encontrados. RESULTADOS:Foram analisados 45 artigos sobre atelectasias pulmonares, sendo 17 artigos em pediatria. Dos artigos com pacientes pediátricos, 13 estudos com série de casos clínicos, três artigos de revisão da literatura e um relato de caso, demonstrando que poucos artigos abordando atelectasias em pediatria foram publicados no período da pesquisa e que o nível de evidência dos artigos existentes são D e E. CONCLUSÃO: Poucos estudos clínicos foram realizados atualmente para identificar o tratamento mais eficaz para a resolução das atelectasias em pediatria. Embora a prática clínica tenha evoluído no tratamento das mesmas, com o aperfeiçoamento das técnicas de broncoscopia e da fisioterapia respiratória existe a necessidade da realização de estudos clínicos randomizados nesta área.

OBJECTIVE: To review the literature about mechanisms, diagnosis and treatment of atelectasis in the pediatric patient. METHODS: An electronic data search was carried out in Medline and Scielo using the following inclusion criteria for articles published between 1960 and 2007 about: atelectasis etiology, physiopathology, functional consequences, evaluation, prevention, treatment and complications, in pediatrics. The used key words were atelectasis, children, pediatrics, mucus plugs, chest physiotherapy; RESULTS: 45 pulmonary atelectasis articles were analyzed, 17 of them in pediatrics. Of the pediatric, 13 were case series, 3 literature reviews and one a case report. This demonstrates that there were few articles on atelectasis during the reviewed period and that these articles were at the D and E evidence level. CONCLUSION: No clinical trials were performed to identify s the most efficient treatment for atelectasis in the pediatric patient. Although clinical practice for treatment of atelectasis has evolved, mostly due to improvement of bronchoscopy and chest physiotherapy techniques, there is still a need to perform randomized clinical trials to address treatment of atelectasis in the pediatric patient.

Caracterización clínica y radiológica de los pacientes ingresados por crisis aguda de asma bronquial durante enero-diciembre de 2007 / Clinical and Radiological Characterization in Patients with Acute Bronchial Asthma Crisis

Se realizó un estudio transversal y descriptivo de 195 pacientes ingresados por crisis aguda de asma bronquial, con el objetivo de caracterizarlos clínica y radiológicamente, los cuales se clasificaron como asma no complicada, complicada con infección y complicada con atelectasia según diagnóstico al ingreso y al egreso. El 43 por ciento, el 26 por ciento y 30 4 por ciento ingresaron por asma no complicada, por complicadas con infección y con atelectasias, respectivamente. Las manifestaciones clínicas más frecuentes las constituyeron la fiebre, los estertores húmedos y la polipnea. No existió diferencia significativa entre los que ingresaron sin complicaciones al ingreso y egreso, sin embargo existe un diagnóstico excesivo de neumonías con relación al egreso; fueron las atelectasias la complicación que con mayor frecuencia se asocian a las crisis de asma bronquial, localizándose en el pulmón derecho y de distribución lobulillar. Por lo que concluimos que la valoración clínica, humoral y radiológica influye en el abordaje diagnóstico y terapéutico adecuado en los pacientes con asma bronquial...(AU)

A descriptive and cross-sectional study in 195 patients admitted with bronchial asthma was carried out aimed at characterizing them from clinical and radiological point of view, commonly associated to infectious and non-infectious complications, mainly located in the right lung atelectasis complication. 43 percent, 26 6 percent and 30 4 percent of the patients were admitted due to non-complicated asthma, complicated with infections and complicated with atelectasis respectively. Fever, humid rale and polypnea constituted the most frequent clinical manifestations. There was no significant difference in non-complicated patients. Atelectasis represented the most frequent complication associated with bronchial asthma. Clinical, radiological and humoral assessments influence in the adequate diagnosis and therapy...(AU)