RESUMEN
PURPOSE: Non-invasive positive pressure ventilation (NIPPV) has gained popularity over the years in the treatment of acute respiratory failure (ARF). Preliminary evidence suggests that delirium is an important factor contributing to NIPPV failure and death. This study was conducted to evaluate delirium and other associated factors of deaths in patients with ARF requiring the use of NIPPV. METHODS: A prospective observational study was conducted in a specialised NIPPV unit. Consecutive patients admitted for ARF requiring NIPPV were assessed by a psychiatrist for presence of delirium using the Diagnostic and Statistical Manual Version IV (DSM-IV). APACHE II score, co-morbidities-, and lung function were also assessed. Patients were followed until their deaths for a minimum of 1 year. Univariate and multivariate Cox's regression analyses were performed to explore predictive factors for death. RESULTS: A total of 153 subjects were recruited, 49 (32.0 %) of whom had delirium. On univariate analysis, higher APACHE II score, lower BMI, presence of delirium, higher Charlson's co-morbidity index but not FEV1 were associated with earlier death. On multivariate analysis, delirium (HR 4.4; 95 % CI 2.6-7.4; p < 0.001) and lower BMI (HR 0.92; 95 % CI 0.86-0.98; p = 0.013) were independently associated with earlier death within 1 year. CONCLUSIONS: There is a high prevalence of delirium in patients requiring NIPPV. The presence of delirium is a strong predictor of mortality. There is strong need to identify and manage these high-risk patients to improve their mortality. The collaboration between psychiatrists and physicians should be strengthened.
Asunto(s)
Delirio/epidemiología , Ventilación no Invasiva , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/terapia , APACHE , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Comorbilidad , Delirio/diagnóstico , Delirio/mortalidad , Femenino , Estudios de Seguimiento , Hong Kong/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Insuficiencia Respiratoria/mortalidad , Tasa de SupervivenciaRESUMEN
Synovial sarcomas are uncommon soft tissue tumours. Immunohistochemistry and cytogenetic techniques are essential for proper diagnosis and differentiation from other spindle cell neoplasms. A case of mediastinal synovial sarcoma is described, of which the unusual location, diagnosis and treatment form the basis of this report.