RESUMO
Postintubation stenosis is the most frequent cause of benign tracheal stenosis and may cause reintubation and delay in weaning of intensive care unit patients. This case study describes typical patients with tracheal stenosis and the management of these patients. Five patients requiring reintubation and mechanical ventilation due to early intubation-related stenosis are discussed. Stridor developed in three cases after extubation. In these cases, bronchoscopy revealed tracheal stenosis. Dilatation and silicone stent placement were performed using rigid bronchoscopy. The other two patients were on ventilators when they were admitted to the intensive care unit and their stenoses were also treated by rigid bronchoscopy. Hypercapnia and hypoxia resolved after intervention in three cases. Of the remaining two patients, one had the tracheostomy closed and in the other patient ventilation was stopped but the tracheostomy was maintained. Tracheal stenosis developing in the subglottic region after extubation, especially after exposure to cuff pressure, may lead to reintubation. A tracheostomy may hinder the diagnosis of progressive stenosis and may lead to unnecessary maintenance of ventilator treatment. Early intubation-related tracheal stenosis should therefore be considered in cases of weaning or extubation failure and prompt appropriate investigation and treatment.
Assuntos
Remoção de Dispositivo , Intubação Intratraqueal , Respiração Artificial/métodos , Estenose Traqueal/patologia , Adulto , Broncoscopia/métodos , Feminino , Humanos , Hipercapnia/etiologia , Hipóxia/etiologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Stents , Fatores de Tempo , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Traqueostomia/métodos , Desmame do RespiradorRESUMO
Tuberculosis is seen with an increased frequency in cancer patients. Possible reasons of reactivation are thought to be related to chemotherapy and insufficient nutrition together with compromised immune system. The diagnosis of tuberculosis may be missed in cancer patients and may be diagnosed with newly developed radiological and clinical findings during treatment. In this case, tuberculosis should be considered and related diagnostic work up should be completed. Also, PPD test should be applied to cancer patients and if needed isoniazid prophylaxis should be initiated. We present herein 4 cancer patients diagnosed with pulmonary tuberculosis. Two patients suffered from solid malignancies (lung cancer) and 2 from non-solid malignancies (acute myeloid leukemia).