Asunto(s)
Manejo de la Vía Aérea/instrumentación , Manejo de la Vía Aérea/métodos , Pulmón/cirugía , Traqueostomía/instrumentación , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Complicaciones Posoperatorias/terapia , Respiración Artificial , Insuficiencia Respiratoria/etiologíaRESUMEN
Single lung transplantation (SLT) is now successfully used in patients with severe emphysema. Mechanical imbalance between the native emphysematous and the healthy transplanted lung can be easily managed, unless severe graft failure occurs, leading to acute respiratory failure. Emergency retransplantation has been used in this setting, since the conventional approach to adult respiratory distress syndrome (ARDS) (mechanical ventilation and positive end-expiratory pressure [PEEP]) fails, due to the mechanical discrepancy between the two lungs. We describe two cases of severe graft failure following SLT in emphysema patients that were successfully treated with prolonged independent respiratory treatment. Mechanical ventilation and PEEP were applied to the failing transplanted lung while the native emphysematous lung was maintained on spontaneous breathing to avoid hyperexpansion and barotrauma. The independent lung respiratory treatment lasted 35 and 25 days, respectively: to our knowledge, these are among the longest-lasting independent respiratory treatments reported. The management was simplified by the early use of a double-lumen tracheostomy cannula as an alternative to orotracheal double lumen tube.
Asunto(s)
Trasplante de Pulmón/fisiología , Pulmón/fisiopatología , Enfisema Pulmonar/fisiopatología , Enfisema Pulmonar/cirugía , Respiración Artificial/métodos , Rechazo de Injerto , Humanos , Ventilación con Presión Positiva Intermitente , Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Rendimiento Pulmonar/fisiología , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva , Intercambio Gaseoso Pulmonar/fisiología , Ventilación Pulmonar/fisiología , TraqueostomíaRESUMEN
We describe the combined use of mask CPAP (continuous positive airway pressure) and minitracheotomy as an alternative to conventional endotracheal intubation in 3 patients requiring CPAP, secretion removal and diagnostic procedures such as bronchoalveolar lavage and bronchial cultures. These requirements were fulfilled with the combined technique approach, thus preserving glottic function and avoiding the disadvantages of endotracheal intubation of tracheotomy. This approach seems particularly suitable in the treatment of immunocompromised patients because of its reduced invasiveness.
Asunto(s)
Máscaras/normas , Respiración con Presión Positiva/instrumentación , Insuficiencia Respiratoria/terapia , Traqueotomía/normas , Adulto , Análisis de los Gases de la Sangre , Humanos , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva/métodos , Insuficiencia Respiratoria/sangreRESUMEN
In a case series of 56 patients with essential cryoglobulinemia, 35 were followed-up for 4-13 years (mean 7 years). A membranous proliferative glomerulonephritis, which in about half the cases showed a progression to renal insufficiency, was the commonest complication, observed in more than one third of the patients. In 2 patients hepatic cirrhosis became manifest after a completely asymptomatic period and in 2 others a lymphoproliferative disease appeared 2 and 8 years after the onset of purpura. In 51% of patients the intial clinical pattern did not change. In searching for a correlation between the development of nephropathy and cryoglobulin characteristics, none was demonstrated studying the cryoglobulin level, the presence of autoantibody and the complement components.