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1.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563668

RESUMO

Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.


Assuntos
Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Adolescente , Reanimação Cardiopulmonar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Síndrome
2.
Medicine (Baltimore) ; 100(1): e24240, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429827

RESUMO

RATIONALE: Negative pressure pulmonary edema (NPPE) is associated with serious postoperative complications. Compact nasal packing is always done after an open rhinoplasty procedure which makes it difficult to achieve positive pressure ventilation via a mask if NPPE arises. PATIENT CONCERNS: A 21-year-old healthy man got an open rhinoplasty, septal perforation repair, and revisional septal reconstruction. After surgery, he became so agitated that it was difficult to calm him. We decided to remove the endotracheal tube. On arrival at the post-anesthesia care unit, he was cyanotic and his SpO2 had decreased to about 2%. We attempted positive pressure ventilation using mask bagging; however, it was ineffective due to the nasal packing. DIAGNOSES: Negative pressure pulmonary edema. INTERVENTIONS: Emergent reintubation was immediately done and Ambu bagging was commenced. A considerable pinkish secretion came out of the tube. A T-piece was applied to him using 15 L/min of oxygen supply. The patient was eventually transferred to the intensive care unit of our hospital. OUTCOMES: On postoperative day (POD) 1, a decision was made to extubate, and the oxygen supply was shifted to 3L/min using a venturi-mask. On POD 2, a chest posteroanterior radiograph was taken and indicated no active lung lesion. The patient was subsequently discharged without any complications. He had no symptoms on POD 6, 11, and 18 at follow-up visits to our outpatient clinic. LESSONS: Anesthesiologists should be alert to the possibility of NPPE and its treatment because of its rapid onset but positive clinical outcome if there is a proper intervention. In nasal surgery cases in particular, early re-intubation should be conducted and extubation should be done to fully awaken the patients.


Assuntos
Extubação/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Edema Pulmonar/diagnóstico , Rinoplastia , Diagnóstico Diferencial , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Adulto Jovem
3.
Kardiologiia ; 60(7): 136-140, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155952

RESUMO

A 29-year old female patient without a history of cardiovascular diseases was admitted on emergency to a surgical hospital with acute calculous cholecystitis in 3 months after uncomplicated term birth. During laparoscopic cholecystectomy, she developed arterial hypotension with pulmonary edema, which required intravenous sympathomimetics. On the next day, after improvement of the condition and stabilization of hemodynamics, cardiac ultrasound showed diffuse left ventricular (LV) hypokinesis with the ejection fraction (EF) of 38 %. Electrocardiogram detected transient left bundle branch block followed by persistent negative T waves in leads I, aVL, and V2 V6. Troponin I concentration was increased to 1.2 ng /ml. Beta-blocker and angiotensin-converting enzyme inhibitor were administered. At 10 days, the LV contractile function completely recovered with LV EF of 59 %. Magnetic resonance imaging did not reveal any signs of myocardial infarction or myocarditis. A differential diagnosis was performed between peripartum cardiomyopathy and Takotsubo syndrome. Considering the fast recovery of LV systolic function, the patient was discharged with a diagnosis of Takotsubo syndrome.


Assuntos
Cardiomiopatias , Hipotensão , Edema Pulmonar , Cardiomiopatia de Takotsubo , Adulto , Cardiomiopatias/diagnóstico , Feminino , Humanos , Período Periparto , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico
4.
Clin Immunol ; 217: 108509, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32535188

RESUMO

BACKGROUND: National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. METHODS: All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. RESULTS: Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. CONCLUSION: In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.


Assuntos
Doença das Coronárias/diagnóstico , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus/diagnóstico , Hipertensão/diagnóstico , Falência Renal Crônica/diagnóstico , Pneumonia Viral/diagnóstico , Edema Pulmonar/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Fatores Etários , Idoso , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Comorbidade , Doença das Coronárias/epidemiologia , Doença das Coronárias/imunologia , Doença das Coronárias/mortalidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/mortalidade , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/imunologia , Diabetes Mellitus/mortalidade , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Hipertensão/imunologia , Hipertensão/mortalidade , Período de Incubação de Doenças Infecciosas , Itália/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/imunologia , Falência Renal Crônica/mortalidade , Contagem de Linfócitos , Linfócitos/imunologia , Linfócitos/patologia , Linfócitos/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Edema Pulmonar/epidemiologia , Edema Pulmonar/imunologia , Edema Pulmonar/mortalidade , Fatores de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/imunologia , Síndrome Respiratória Aguda Grave/mortalidade , Índice de Gravidade de Doença , Análise de Sobrevida
5.
J Cardiovasc Surg (Torino) ; 61(2): 256-263, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31985187

RESUMO

We report on the case of spontaneous rupture of an On-X-pure pyrolytic carbon mechanical valve prosthesis implanted seven years earlier, in a mitral position, at our hospital. The patient was admitted with valvular dysfunction and acute pulmonary edema requiring emergency surgery (prosthesis replacement); the absence of a leaflet was confirmed intraoperatively. The patient presented severe respiratory failure, which prolonged the postoperative period. A CT scan showed that the migrated leaflet was located in the aortic bifurcation with no apparent arterial lesion. Four months later, once the patient had recovered, laparotomy and aortotomy were performed in order to retrieve the leaflet, which was found to have become included (neoendothelized) in the aortic wall without compromising the latter's integrity or obstructing the blood flow. A subsequent CT scan confirmed the persistence of the leaflet in its initial position. The literature review highlights two singular facts: 1) this is the second published case of the escape of a leaflet from an On-X prosthesis (the first patient died); 2) this is the first case in which a laparotomy was performed to retrieve the leaflet but finally a decision was made to leave it in situ. Seven months later, the patient remained asymptomatic.


Assuntos
Bioprótese/efeitos adversos , Migração de Corpo Estranho/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Falha de Prótese , Doença Aguda , Procedimentos Cirúrgicos Cardíacos/métodos , Serviço Hospitalar de Emergência , Seguimentos , Migração de Corpo Estranho/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Reoperação/métodos , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
Int J Cardiol ; 299: 192-198, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31281047

RESUMO

INTRODUCTION: Chest X-ray (CXR) widely used, but the prognostic value of congestion quantification using CXR remains uncertain. The main objective of the present study was to assess whether initial quantification of lung congestion evaluated by CXR [and its interplay with estimated plasma volume status (ePVS)] in patients with worsening heart failure (WHF) is associated with in-hospital and short-term clinical outcome. METHODS: We studied 117 patients hospitalized for WHF in the ICALOR HF disease management program. Pulmonary congestion was estimated using congestion score index (CSI, range 0 to 3) evaluated from 6 lung areas on CXR. Systemic congestion was assessed by ePVS. Logistic regression analysis was used to assess length of stay and the composite of all-cause death or HF re-hospitalization at 90 days. RESULTS: Patients were divided according to the median of admission CSI (median = 2.20) and ePVS (median = 5.38). Higher CSI was significantly associated with higher pulmonary arterial systolic pressure in multivariable models. Multivariable models showed patients with high CSI/high ePVS had a 6-day longer length of stay [OR (95% CI) = 6.78 (1.82-29.79), p < 0.01] and 5-fold higher risk of 90-day composite outcome [OR (95% CI) = 5.13 (1.26-25.11) p = 0.03] compared to patients with low CSI/low ePVS, while other configurations (either isolated high CSI or high ePVS) yielded neutral associations. Furthermore, CSI and ePVS significantly improved reclassification on top of clinical covariates for the composite outcome [Net reclassification index = 37.3% (0.52-87.0), p = 0.046]. CONCLUSION: An admission assessment of pulmonary and systemic congestion in WHF patients using CSI and ePVS can identify a cluster of high-risk patients at short-term outcomes.


Assuntos
Insuficiência Cardíaca , Hipertensão Pulmonar , Pulmão , Volume Plasmático , Edema Pulmonar , Idoso , Regras de Decisão Clínica , Progressão da Doença , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Masculino , Escores de Disfunção Orgânica , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Radiografia Torácica/métodos
7.
Braz J Med Biol Res ; 52(12): e9124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826182

RESUMO

Carbohydrate antigen 125 (CA125) has long been used as an ovarian cancer biomarker. However, because it is not specific for ovarian cells, CA125 could also be used to monitor congestion and inflammation in heart disease. Acute heart failure (HF) is used to identify patients with a worse prognosis in ST-segment elevation myocardial infarction (STEMI). We aimed to determine the association of CA125 with acute HF in STEMI and to compare CA125 with N-terminal pro brain natriuretic peptide (NTproBNP) with a cross-sectional study. At admission, patients were examined to define Killip class and then underwent coronary angioplasty. Blood samples, preferably taken in the hemodynamic ward, were centrifuged (1500 g for 15 min at ambient temperature) and stored at -80°C until biomarker assays were performed. Patients were divided into two groups according to the presence or absence of congestion. Patients in Killip class ≥II were in the congestion group and those with Killip

Assuntos
Antígeno Ca-125/sangue , Edema Pulmonar/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Edema Pulmonar/sangue , Edema Pulmonar/diagnóstico , Curva ROC , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue
8.
J. bras. nefrol ; 41(4): 564-569, Out.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056599

RESUMO

ABSTRACT Takayasu arteritis (TA) is a chronic granulomatous inflammatory condition of unknown cause that involves large vessels - particularly the aorta and its branches - such as the carotid, coronary, pulmonary, and renal arteries. The left subclavian artery is the most frequently involved vessel. Stenosis of the renal artery has been reported in 23-31% of the cases and may result in malignant hypertension, ischemic renal disease, decompensated heart failure, and premature death. Involvement of both renal arteries is uncommon. Early onset anuria and acute kidney injury are rare and have been reported only in a few cases in the literature. This report describes the case of a 15-year-old female with constitutional symptoms evolving for a year, combined with headache, nausea, and vomiting, in addition to frequent visits to emergency services and insufficient clinical examination. The patient worsened significantly six months after the onset of symptoms and developed acute pulmonary edema, oliguria, acute kidney injury, and difficult-to-control hypertension, at which point she was admitted for intensive care and hemodialysis. Initial ultrasound examination showed she had normal kidneys and stenosis-free renal arteries. The patient was still anuric after 30 days of hospitalization. A biopsy was performed and revealed her kidneys were normal. Computed tomography angiography scans of the abdominal aorta presented evidence of occlusion of both renal arteries. The patient met the diagnostic criteria for Takayasu arteritis and had a severe complication rarely described in the literature: stenosis of the two renal arteries during the acute stage of ischemic renal disease.


RESUMO A Arterite de Takayasu (AT) é uma doença inflamatória crônica, granulomatosa, de causa desconhecida, que afeta grandes vasos, principalmente a aorta e seus ramos, incluindo artérias carótidas, coronárias, pulmonares e renais, sendo a artéria subclávia esquerda o vaso mais acometido. A estenose da artéria renal é relatada em 23-31% dos casos e pode resultar em hipertensão maligna, insuficiência renal por isquemia, descompensação cardíaca e morte prematura. O acometimento bilateral de artérias renais é incomum, sendo rara a presença de anúria súbita e lesão renal aguda como sintoma inicial da doença, com poucos relatos na literatura. O caso reporta uma adolescente de 15 anos com sintomas constitucionais durante um ano de evolução, associados a problemas como cefaleia, náuseas e vômitos, com idas frequentes a serviços de emergência, sem adequada investigação clínica. Após 6 meses do início dos sintomas, a paciente evoluiu de forma grave, com quadro de edema agudo de pulmão, oligúria, lesão renal aguda e hipertensão arterial de difícil controle, sendo necessário suporte em Unidade de Terapia Intensiva e hemodiálise. A ultrassonografia inicial mostrava rins normais e artérias renais sem sinais de estenose. Após 30 dias de internamento, paciente permanecia anúrica, sendo realizada biópsia renal que se mostrou dentro dos padrões da normalidade. Angiotomografia de aorta abdominal evidenciou oclusão bilateral de artérias renais. A paciente descrita fechou critérios diagnósticos para arterite de Takayasu e manifestou uma complicação grave pouco descrita na literatura: estenose bilateral de artérias renais, ainda na fase aguda da nefropatia isquêmica.


Assuntos
Humanos , Feminino , Adolescente , Obstrução da Artéria Renal/complicações , Lesão Renal Aguda/diagnóstico , Oligúria/diagnóstico , Oligúria/etiologia , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Doença Aguda , Diálise Renal/métodos , Transplante de Rim/métodos , Resultado do Tratamento , Arterite de Takayasu/complicações , Diagnóstico Diferencial , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Hipertensão/diagnóstico , Hipertensão/etiologia
9.
Undersea Hyperb Med ; 46(5): 581-601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683356

RESUMO

Introduction: We aimed to document identified cases of immersion pulmonary edema (IPE) in divers from Oceania (the Indo-Pacific region) from January 2002 to May 2018, inclusive. Method: Cases were identified using various sources, including searches of the Divers Alert Network Asia-Pacific (DAN AP) Fatality Database, published case reports, and interviews with survivors who had reported their incident to DAN AP. Where available, investigations, pathology and autopsy results were obtained. Only incidents diagnosed as IPE by diving physicians or pathologists with experience in the investigation of diving accidents were included. Individual case histories and outcomes, together with brief individual summaries of the associations and possible contributing factors were recorded. Results: Thirty-one IPE incidents in divers from Oceania were documented. There were two surface snorkelers, 22 scuba air divers and seven nitrox divers which included three closed-circuit rebreathers (CCR). The mean (SD) age was 53 (12) years, 58% of victims were females, and the average dive profile was to a maximum depth of 19 meters of seawater for 25 minutes. Six victims (19%) had previous episodes of IPE. There were nine recorded fatalities. Cardiac anomalies dominated the associated or possible contributing factors. These included valvular disease in 29%, transient cardiomyopathies in 26% and dysrhythmias in 16%. Conclusions: Previously reported associations of IPE such as exertion, stress, cold exposure, negative inspiratory pressure, hypertension, overhydration, ascent or surfacing, tight wetsuit, aspiration and certain medications were identified. Cardiac conditions were frequent and included chronic disorders (valvular pathology, coronary artery disease) and transient disorders (dysrhythmias, transient myocardial dysfunction, takotsubo or stress cardiomyopathy). It is likely that the chronic cardiac disorders may have contributed to the IPE, whereas the transient cases could be either sequelae, contributors or coincidental to the IPE.


Assuntos
Mergulho/efeitos adversos , Edema Pulmonar/etiologia , Adulto , Idoso , Autopsia , Doença das Coronárias/patologia , Suscetibilidade a Doenças/etiologia , Suscetibilidade a Doenças/patologia , Evolução Fatal , Feminino , Cardiopatias/complicações , Humanos , Imersão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oceania/epidemiologia , Esforço Físico , Edema Pulmonar/diagnóstico , Edema Pulmonar/epidemiologia , Edema Pulmonar/patologia , Fatores de Risco , Água do Mar , Distribuição por Sexo , Natação , Cardiomiopatia de Takotsubo/complicações , Adulto Jovem
10.
Undersea Hyperb Med ; 46(5): 603-610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683357

RESUMO

Aim: To review incidents of immersion pulmonary edema (IPE) from Oceania, to determine the demographics, diving parameters, and comorbidities that may be related to this disorder. Method: Incidents of IPE, most of which were documented by Divers Alert Network Asia-Pacific (DAN AP) or reported in our medical literature, were analyzed. They included interviews with the survivors and a review of available medical records. Only incidents diagnosed as IPE by specialist diving physicians or pathologists with experience in the investigation of diving accidents were included. Results: Thirty-one IPE incidents in divers from Oceania were documented. There were two surface snorkelers, 22 scuba air divers and seven nitrox divers, which included three closed-circuit rebreathers (CCR). The mean (SD) age was 53 (12) years, 58% of victims were females, and the average dive profile was to a maximum depth of 19 msw for 25 minutes. Six victims (19%) had previous episodes of IPE. There were nine recorded fatalities in this cohort. Medical comorbidities were recorded in 68%, with 42% being cardiac. The latter included valvular disease in 29%, transient cardiomyopathies in 26% and dysrhythmias in 16%. Conclusion: IPE was more likely in middle-aged females, in experienced divers, and during ascent or after surfacing. Commonly reported associations such as exertion, stress, cold exposure, negative inspiratory pressure, hypertension, overhydration, tight wetsuit, aspiration and certain medications were identified. This series supports the hypothesis that the elderly IPE subjects are likely to have comorbidities and be susceptible to IPE recurrences and fatalities unless the contributing factors can be identified and addressed.


Assuntos
Mergulho/efeitos adversos , Edema Pulmonar/etiologia , Adulto , Fatores Etários , Idoso , Autopsia , Temperatura Baixa/efeitos adversos , Comorbidade , Mergulho/estatística & dados numéricos , Feminino , Cardiopatias/complicações , Humanos , Imersão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oceania , Edema Pulmonar/diagnóstico , Edema Pulmonar/mortalidade , Edema Pulmonar/patologia , Fatores de Risco , Água do Mar , Adulto Jovem
11.
Arch Cardiovasc Dis ; 112(12): 748-753, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690520

RESUMO

BACKGROUND: Oxygen therapy remains a cornerstone of treatment for acute heart failure in patients with pulmonary congestion. While avoiding hypoxaemia has long been a goal of critical care practitioners, less attention has been paid to the potential hazard related to excessive hyperoxia. AIM: To evaluate the impact of early hyperoxia exposure among critically ill patients hospitalized in an intensive care unit for acute heart failure. METHODS: In this preliminary study conducted in a Parisian intensive care unit, we assessed patients with acute heart failure admitted with pulmonary congestion and treated with oxygen therapy from 1 January 2015 to 31 December 2016. The hyperoxia group was defined by having at least one partial pressure of oxygen measurement>100mmHg on the first day following admission to the intensive care unit. The primary endpoint was 30-day all-cause mortality. Secondary endpoints were 30-day unplanned hospital admissions, occurrence of infections and intensive care unit and hospital lengths of stay. RESULTS: Seventy-five patients were included. Forty-three patients (57.3%) presented hyperoxia, whereas 32 patients (42.7%) did not (control group). The baseline clinical characteristics did not differ between the two groups. The primary endpoint was not statistically different between the two groups (14.0% in the hyperoxia group vs 18.8% in the control group; P=0.85). The secondary endpoints were also not significantly different between the two groups. In the multivariable analysis, hyperoxia was not associated with increased 30-day mortality (odds ratio 0.77, 95% confidence interval 0.24-2.41). CONCLUSION: In patients referred to an intensive care unit for acute heart failure, we did not find any difference in outcomes according to the presence of hyperoxia.


Assuntos
Insuficiência Cardíaca/terapia , Hiperóxia/etiologia , Unidades de Terapia Intensiva , Oxigenoterapia/efeitos adversos , Admissão do Paciente , Edema Pulmonar/terapia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Hiperóxia/diagnóstico , Hiperóxia/mortalidade , Hiperóxia/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/mortalidade , Paris , Readmissão do Paciente , Dados Preliminares , Edema Pulmonar/diagnóstico , Edema Pulmonar/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
12.
Eur J Heart Fail ; 21(12): 1605-1613, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31667987

RESUMO

AIMS: Lung ultrasound (LUS) is a useful tool with which to assess subclinical pulmonary congestion and to stratify the prognosis of patients with heart failure (HF). The aim of this study was to evaluate whether an LUS-guided follow-up protocol improves the outcomes of patients with HF. METHODS AND RESULTS: In this single-blind clinical trial, 123 patients admitted for HF were randomized to either a standard follow-up (n = 62, control group) or a LUS-guided follow-up (n = 61, LUS group). The primary endpoint was a composite of urgent visit, hospitalization for worsening HF and death during follow-up. Visits were scheduled at 14, 30, 90 and 180 days after discharge. Treating physicians were encouraged to modify diuretic therapy in accordance with the number of B-lines recorded by LUS. The mean ± standard deviation (SD) age of the patients was 69 ± 12 years and 72% were male. The mean ± SD left ventricular ejection fraction was 39 ± 14%. The hazard ratio for the primary outcome in the LUS group was 0.518 [95% confidence interval (CI) 0.268-0.998; P = 0.049], mainly resulting from a decrease in the number of urgent visits for worsening HF. The number of patients needed to treat to avoid an event was 5 (95% CI 3-62). Other secondary endpoints such as N-terminal pro-B-type natriuretic peptide reduction were not achieved. The safety parameters were similar in the two groups. Patients in the LUS group received more loop diuretics [51 (91%) vs. 42 (75%); P = 0.02] and showed an improvement in the distance achieved in the 6-min walking test [60 m (interquartile range: 29-125 m) vs. 37 m (interquartile range: 5-70 m); P = 0.023]. CONCLUSIONS: Tailored LUS-guided diuretic treatment of pulmonary congestion in this proof-of-concept study reduced the number of decompensations and improved walking capacity in patients with HF. LUS is a non-invasive, safe and easy-to-use technique with potential clinical applicability to guide pulmonary congestion treatment in patients with HF.


Assuntos
Diuréticos/administração & dosagem , Insuficiência Cardíaca/complicações , Pulmão/diagnóstico por imagem , Pacientes Ambulatoriais , Edema Pulmonar/tratamento farmacológico , Volume Sistólico/fisiologia , Ultrassonografia de Intervenção/métodos , Idoso , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Prognóstico , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Estudos Retrospectivos , Método Simples-Cego , Resultado do Tratamento , Função Ventricular Esquerda
13.
Sci Rep ; 9(1): 15029, 2019 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-31636276

RESUMO

Paraquat poisoning has become a serious public health problem in some Asian countries because of misuse or suicide. We sought to develop and validate a radiomics nomogram incorporating radiomics signature and laboratory bio-markers, for differentiating bacterial pneumonia and acute paraquat lung injury. 180 patients with pneumonia and acute paraquat who underwent CT examinations between December 2014 and October 2017 were retrospectively evaluated for testing and validation. Clinical information including demographic data, clinical symptoms and laboratory test were also recorded. A prediction model was built by using backward logistic regression and presented on a nomogram. The radiomics-based features yielded areas under the receiver operating characteristic curve of 0.870 (95% CI 0.757-0.894), sensitivity of 0.857, specificity of 0.804, positive predictive value of 83.3%, negative predictive value of 0.818 in the primary cohort, while in the validation cohort the model showed similar results (0.865 (95% CI 0.686-0.907), 0.833, 0.792, 81.5%, respectively). The individualized nomogram included radiomics signature, body temperature, nausea and vomiting, and aspartate transaminase. We have developed a radiomics nomogram that combination of the radiomics features and clinical risk factors to differentiate paraquat lung injury and pneumonia for patients with an unclear medical history of exposure to paraquat poisoning, providing appropriate therapy decision support.


Assuntos
Nomogramas , Pneumonia/diagnóstico , Edema Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X , Doença Aguda , Adulto , Algoritmos , Calibragem , Tomada de Decisão Clínica , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pneumonia/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Curva ROC , Reprodutibilidade dos Testes
14.
Laeknabladid ; 105(11): 499-507, 2019 Nov.
Artigo em Islandês | MEDLINE | ID: mdl-31663513

RESUMO

Upon reaching a height over 2500 m above seal level symptoms of altitude illness can develop over 1 - 5 days. The risk is mainly -determined by the altitude and rate of ascent and the symptoms vary. Most common are symptoms of acute mountain illness (AMS) but more dangerous high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE) can also develop. The causes of AMS, HACE and HAPE are lack of oxygen and insufficient acclimatization, but the presenting form is determined by the responses of the body to the lack of oxygen. The most common symptoms of AMS include headache, fatique and nausea, but insomnia and nausea are also common. The most common symptoms of HAPE are breathlessness and lassitude whereas the cardinal sign of HACE is ataxia, but confusion and loss of consciousness can also develop. In this article all three main forms of altitude illness are reviewed. The emphasis is on preventive measures and treatment but new knowledge on pathogenesis is also addressed.


Assuntos
Doença da Altitude/etiologia , Altitude , Edema Encefálico/etiologia , Edema Pulmonar/etiologia , Doença da Altitude/diagnóstico , Doença da Altitude/fisiopatologia , Doença da Altitude/prevenção & controle , Edema Encefálico/diagnóstico , Edema Encefálico/fisiopatologia , Edema Encefálico/prevenção & controle , Humanos , Prognóstico , Edema Pulmonar/diagnóstico , Edema Pulmonar/fisiopatologia , Edema Pulmonar/prevenção & controle , Medição de Risco , Fatores de Risco
15.
Cancer Chemother Pharmacol ; 84(4): 849-860, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31428821

RESUMO

PURPOSE: Thiotepa is used in high-dose chemotherapy (HDT) before autologous hematopoietic stem cell transplantation (HSCT) to treat solid tumors and hematological malignancies. This Phase 1 study was conducted to establish the pharmacokinetics (PK) of thiotepa in a Japanese population. METHODS: HDT/HSCT was performed in pediatric patients (≥ 2 years) with solid tumors or brain tumors (thiotepa 200 mg/m2/day IV-infused over 24 h on HSCT Days - 12, - 11, - 5, and - 4 and melphalan 70 mg/m2/day IV-infused over 1 h on Days - 11, - 5, and - 4) and adult patients (≥ 16 years) with malignant lymphoma (thiotepa 200 mg/m2/day 2-h IV-infusion on HSCT Days - 4 and - 3 plus busulfan 0.8 mg/kg 2-h IV-infusion every 6 h from HSCT Days - 8 to - 5). Pharmacokinetics of thiotepa were assessed following initial dose. Safety and efficacy were also evaluated. RESULTS: Nine pediatric and 10 adult patients were enrolled. Mean volume of distribution (Vz) of thiotepa normalized with body surface area (BSA) was lower for pediatric patients (16.4 L/m2) compared with adult patients (26.4 L/m2) as expected due to the higher specific surface area of children. Clearance and biological half-life were similar between pediatric and adult patients. Two serious adverse events (cardiac arrest and pulmonary edema) were observed. Survival rate (Day 100 post-HSCT) was 77.8% (95% CI 36.5-93.9%) for pediatric patients and 100% for adult patients. CONCLUSION: Thiotepa elimination was comparable in pediatric and adult patients with cancer. Lower Vz in pediatric compared with adult patients was expected. HDT with thiotepa prior to autologous HSCT was well tolerated. STUDY REGISTRATION: Japic CTI-163433.


Assuntos
Neoplasias Encefálicas , Neoplasias Hematológicas , Linfoma , Tiotepa , Fatores Etários , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Alquilantes/efeitos adversos , Antineoplásicos Alquilantes/farmacocinética , Superfície Corporal , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/patologia , Criança , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Feminino , Parada Cardíaca/induzido quimicamente , Parada Cardíaca/diagnóstico , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/patologia , Humanos , Linfoma/tratamento farmacológico , Linfoma/patologia , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Processos e Resultados em Cuidados de Saúde , Edema Pulmonar/induzido quimicamente , Edema Pulmonar/diagnóstico , Tiotepa/administração & dosagem , Tiotepa/efeitos adversos , Tiotepa/farmacocinética
16.
Intensive Care Med ; 45(9): 1200-1211, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31418060

RESUMO

This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pulmonary embolism, pneumonia, interstitial processes, and the patient on mechanical ventilatory support. Mastery of lung and pleural ultrasonography allows the intensivist to rapidly diagnose and guide the management of a wide variety of disease processes that are common features of critical illness. Its ease of use, rapidity, repeatability, and reliability make thoracic ultrasonography the "go to" modality for imaging the lung and pleura in an efficient, cost effective, and safe manner, such that it can largely replace chest imaging in critical care practice. It is best used in conjunction with other components of critical care ultrasonography to yield a comprehensive evaluation of the critically ill patient at point of care.


Assuntos
Doenças Torácicas/diagnóstico por imagem , Doenças Torácicas/diagnóstico , Ultrassonografia/métodos , Cuidados Críticos/métodos , Humanos , Derrame Pleural/diagnóstico , Derrame Pleural/diagnóstico por imagem , Pneumonia/diagnóstico , Pneumonia/diagnóstico por imagem , Pneumotórax/diagnóstico , Pneumotórax/diagnóstico por imagem , Edema Pulmonar/diagnóstico , Edema Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Doenças Torácicas/fisiopatologia
17.
Crit Care ; 23(1): 288, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455421

RESUMO

BACKGROUND: This pilot study was designed to develop a fully automatic and quantitative scoring system of B-lines (QLUSS: quantitative lung ultrasound score) involving the pleural line and to compare it with previously described semi-quantitative scores in the measurement of extravascular lung water as determined by standard thermo-dilution. METHODS: This was a prospective observational study of 12 patients admitted in the intensive care unit with acute respiratory distress and each provided with 12 lung ultrasound (LUS) frames. Data collected from each patient consisted in five different scores, four semi-quantitative (nLUSS, cLUSS, qLUSS, %LUSS) and quantitative scores (QLUSS). The association between LUS scores and extravascular lung water (EVLW) was determined by simple linear regression (SLR) and robust linear regression (RLR) methods. A correlation analysis between the LUS scores was performed by using the Spearman rank test. Inter-observer variability was tested by computing intraclass correlation coefficient (ICC) in two-way models for agreement, basing on scores obtained by different raters blinded to patients' conditions and clinical history. RESULTS: In the SLR, QLUSS showed a stronger association with EVLW (R2 = 0.57) than cLUSS (R2 = 0.45) and nLUSS (R2 = 0.000), while a lower association than qLUSS (R2 = 0.85) and %LUSS (R2 = 0.72) occurred. By applying RLR, QLUSS showed an association for EVLW (R2 = 0.86) comparable to qLUSS (R2 = 0.85) and stronger than %LUSS (R2 = 0.72). QLUSS was significantly correlated with qLUSS (r = 0.772; p = 0.003) and %LUSS (r = 0.757; p = 0.005), but not with cLUSS (r = 0.561; p = 0.058) and nLUSS (r = 0.105; p = 0.744). Moreover, QLUSS showed the highest ICC (0.998; 95%CI from 0.996 to 0.999) among the LUS scores. CONCLUSIONS: This study demonstrates that computer-aided scoring of the pleural line percentage affected by B-lines has the potential to assess EVLW. QLUSS may have a significant impact, once validated with a larger dataset composed by multiple real-time frames. This approach has the potentials to be advantageous in terms of faster data analysis and applicability to large sets of data without increased costs. On the contrary, it is not useful in pleural effusion or consolidations.


Assuntos
Algoritmos , Pulmão/fisiopatologia , Projetos de Pesquisa/normas , Ultrassonografia/classificação , Adulto , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Edema Pulmonar/diagnóstico , Edema Pulmonar/fisiopatologia , Projetos de Pesquisa/estatística & dados numéricos , Ultrassonografia/métodos
19.
Anaesthesia ; 74(10): 1282-1289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31273760

RESUMO

The measurement of extravascular lung water is a relatively new technology which has not yet been well validated as a clinically useful tool. We studied its utility in patients undergoing pulmonary endarterectomy as they frequently suffer reperfusion lung injury and associated oedematous lungs. Such patients are therefore ideal for evaluating this new monitor. We performed a prospective observational cohort study during which extravascular lung water index measurements were taken before and immediately after surgery and postoperatively in intensive care. Data were analysed for 57 patients; 21 patients (37%) experienced severe reperfusion lung injury. The first extravascular lung water index measurement after cardiopulmonary bypass failed to predict severe reperfusion lung injury, area under the receiver operating characteristic curve 0.59 (95%CI 0.44-0.74). On intensive care, extravascular lung water index correlated most strongly at 36 h, area under the receiver operating characteristic curve 0.90 (95%CI 0.80-1.00). Peri-operative extravascular lung water index is not a useful measure to predict severe reperfusion lung injury after pulmonary endarterectomy, however, it does allow monitoring and measurement during the postoperative period. This study implies that extravascular lung water index can be used to directly assess pulmonary fluid overload and that monitoring patients by measuring extravascular lung water index during their intensive care stay is useful and correlates with their clinical course. This may allow directed, pre-empted therapy to attenuate the effects and improve patient outcomes and should prompt further studies.


Assuntos
Endarterectomia/efeitos adversos , Água Extravascular Pulmonar , Lesão Pulmonar/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Artéria Pulmonar/cirurgia , Traumatismo por Reperfusão/diagnóstico , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Curva ROC , Termodiluição
20.
Thorac Cancer ; 10(9): 1834-1836, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290272

RESUMO

Re-expansion pulmonary edema is a rare complication that may occur after chest drainage performed for pneumothorax. This condition manifests as areas of ground-glass opacities (GGO) and septal thickening on imaging studies. In the case reported here, chest computed tomography (CT) showed diffuse ground-glass opacity secondary to ruptured bullae in a patient who underwent chest tube drainage for pneumothorax, suggesting re-expansion pulmonary edema. Histopathological examination of lung tissue resected from the vicinity of the bullae showed focal adenocarcinoma, which was masked by re-expansion pulmonary edema on preoperative computed tomography. Right upper lobectomy with mediastinal lymph node dissection was performed on postoperative day 3.


Assuntos
Adenocarcinoma/diagnóstico , Drenagem/efeitos adversos , Neoplasias Pulmonares/diagnóstico , Pneumotórax/terapia , Edema Pulmonar/diagnóstico , Adenocarcinoma/etiologia , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Pneumotórax/patologia , Prognóstico , Edema Pulmonar/etiologia
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