RESUMO
BACKGROUND AND OBJECTIVES: Although anoxic encephalopathy is the most dreaded consequence of submersion accidents, respiratory involvement is also very common in these patients. Nevertheless, few data are available about the clinical course and resolution of lung injury in adult victims of near-drowning. Our goal was to study the clinical manifestations of near-drowning and the course of respiratory involvement in a retrospective cohort of adult, mostly elderly patients. PATIENTS: Our study included adult patients who were hospitalized after near-drowning in seawater over an 8-year period. Forty-three patients (26 female, 17 male), with an age range of 18-88 years old, were studied. Most (79%) of the patients were elderly (>60 years). RESULTS: In the Emergency Department two patients were comatose and required intubation. Another patient was intubated within the first 24 h because of ARDS. At presentation, all patients but two had a PaO(2)/FiO(2) < 300, while ARDS was present in 17 and acute lung injury in 15 cases. The nine remaining hypoxemic patients had either focal infiltrates or a negative chest X-ray. Superimposed pneumonia was observed in four patients and resulted in a protracted hospital stay. Improvement of lung injury was rapid in most cases: by day 4 resolution of hypoxemia was observed in 33/43 (76.7%) of the cases and resolution of radiographic findings in 66.6%. Duration of hospitalization varied from 2 to 14 days (mean = 5.2 +/- 0.5 days). One patient with coma died due to ventilator-associated pneumonia (mortality = 2.3%). CONCLUSION: Respiratory manifestations of near-drowning in adult immersion victims are often severe. Nevertheless, in noncomatose patients at least, intubation can often be avoided and quick improvement is the rule while a good outcome is usually expected even in elderly patients.
Assuntos
Lesão Pulmonar Aguda/etiologia , Afogamento Iminente/complicações , Síndrome do Desconforto Respiratório/etiologia , Lesão Pulmonar Aguda/diagnóstico por imagem , Lesão Pulmonar Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Coma/etiologia , Feminino , Humanos , Hipóxia/etiologia , Intubação Intratraqueal , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Edema Pulmonar/etiologia , Radiografia , Respiração Artificial , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/terapia , Estudos Retrospectivos , Água do Mar , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Acute eosinophilic pneumonia (AEP) is a severe syndrome which can be induced for many reasons, including drugs. AEP has rarely been associated with first-generation antipsychotics and never been reported after use of second-generation antipsychotics, such as risperidone. CASE REPORT: We report a case of a 64-year-old man with a medical history of alchoholism and paranoid symptoms, treated with risperidone at low doses. Following risperidone medication, he presented with respiratory distress. Bronchoalveolar lavage (BAL) specimen was indicated of AEP. All evidence indicated risperidone as the most probable causal factor. The syndrome rapidly resolved after discontinuation of the drug. DISCUSSION: Pathophysiological mechanisms implicated in the development of AEP in our patient seem to be associated with eotaxin and serotonin eosinophilic-specific chemoattracting action, through the serotoninergic action of risperidone. CONCLUSION: To our knowledge, this is the first case report of a clinical adverse reaction of AEP from an atypical antipsychotic agent (risperidone).
Assuntos
Antipsicóticos/efeitos adversos , Eosinofilia Pulmonar/induzido quimicamente , Risperidona/efeitos adversos , Doença Aguda , Humanos , Masculino , Pessoa de Meia-Idade , Eosinofilia Pulmonar/diagnósticoRESUMO
The prevalence and significance of sleep-disordered breathing (SDB) in dialysis-independent chronic renal failure (CRF) remains unknown. We studied the presence of SDB in nondialyzed CRF patients. Diagnostic polysomnography was performed in consecutive stable nondialyzed CRF patients. Inclusion criteria were age
Assuntos
Nefropatias Diabéticas/complicações , Falência Renal Crônica/complicações , Síndromes da Apneia do Sono/complicações , Fatores Etários , Índice de Massa Corporal , Creatinina/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Síndrome das Pernas Inquietas/complicações , Índice de Gravidade de Doença , Ureia/análiseRESUMO
We present a case of drug- induced pneumonitis caused by carvedilol. Forty days after drug cessation, there was almost complete resolution of pulmonary infiltrates. This is the first report of pneumonitis caused by carvedilol.