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Noninvasive ventilation in post extubation acute respiratory failure
Teresa Honrado, J. Chaves Caminha, Álvaro M. Silva, Sofia Esperança, A. Paes Cardoso, Fernando Rua
Abstract:
Several studies reported the efficacy of Noninvasive
Ventilation (NIV) in avoiding reintubation in patients
who developed acute respiratory failure shortly after
extubation. In this study NIV was administered to 20
patients with different diagnoses who experienced
respiratory distress after extubation. All of them, where
considered weaned and met the extubation criteria. NIV
was delivered by nasal mask connected to a BiPAP
ventilator (Respironics Inc.).
NIV was successful in avoiding tracheal reintubation in
12 patients (60% rate of success), and significantly
reduced the length of ICU stay of the patients
successfully ventilated with NIV, when compared with
those who failed. There was no differences in the
diagnoses related to ARF between the two groups. Data
analysis showed that there was no significant differences
at base-line arterial blood gas levels before initiating
NIV and these values did not predict the response to NIV.
We concluded that application of NIV is effective in a
selected group of patients who dveloped ARF shortly after
extubation, reducing the rate of tracheal reintubations
and the length of ICU stay.
Keywords: Noninvasive Ventilation, Postextubation
Acute Respiratory Failure, BiPAP, Prediction of Success.
Fiberoptic bronchoscopy in ICU patients
A. Oliveira Meleiro, A. C. Duarte, P. Cravo, A. Mineiro, M. G. Freitas
Summary:
We analysed 463 fiberoptic bronchoscopies which were
performed on patients admitted to our ICU from 1992 to
1995, according to the American Thoracic Society
Guidelines.
The results obtained confirmed the therapeutic and
diagnostic relevance of fiberoptic bronchoscopy and
showed the safety of the technique.
Keywords: Fiberoptic Bronchoscopy in ICU´s:
Fiberoptic Bronchoscopy in ventilade patients.
Transbronchial biopsy during mechanical ventilation
J. Chaves Caminha, Álvaro M. Silva, F. Rua
Summary:
Patients with progressive or persistent pulmonary
infiltrates which require mechanical ventilation and who
are not clinically improving their condition, may require
lung tissue examination to establish a specific
diagnosis. Since 1994 we performed 4 transbronchial
biopsies (TBB) in patients with these conditions. we
decide to perform TBB to increase the diagnostic yield of
flexible fiberoptic bronchoscopy in conjunction with the
bronchoalveolar lavage (BAL). TBB was diagnostic in three
patients, and in one additional case the diagnostic was
made from the accompanying liquid of bronchoalveolar
lavage. We had one tension pneumothorax as a complication
to TBB. No fatalities were attributable to TBB. In these
hemodynamically stable patients requiring mechanical
ventilation for diffuse lung disease, TBB was performed
safely and provided important data, which showed that the
diagnostic yeld of flexible fiberoptic bronchoscopy
increased and the therapeutic management was modified.
However BAL remains the first approach.
Keywords: Fiberoptic Bronchoscopy, Transbronchial
Biopsy, Bronchoalveolar Lavage, Mechanical Ventilation.
Nutrition in renal failure
Anabela Rodrigues, Isabel Fonseca, Aníbal Marinho
Summary:
With the improvement of the methods of hemodynamic
resuscitation and cardiorespiratory support, there has
been a progressive reduction in the incidence of acute
renal failure (IRA) in the ICU´s. However, the
associated mortality rate has remained high even though
progress has continued to be made in both conventional
hemodyalisis and in the new thecniques of renal
replacement therapy.
Nowadays it is known undernutrition is associated with
many of the factors which give rise to the occurrence of
acute renal failure, or a sharp reduction in the renal
function of patients with chronic renal failure. The
authors present a review concerning about nutritional
support of patients with renal failure.
Keywords: nutrition, renal failure, albumine,
hemodyalisis, renal replacement therapy.
Continuous renal replacement therapy: indications and pratice
Rui Castro, João Pedro S. Pimentel, Aníbal Marinho, Manuela Sousa, Anselmo Madureira, António Paes Cardoso, Serafim Guimarães
Summary: Continuous Renal Replacement Theraphy
(CRRT) is a major tool to any modern Intensive Care Unit.
Its application has been extended from cases of acute
renal failure with hemodinamic instability and toxins
depuration to severe pathologies such as A.R.D.S. (Adult
Respiratory Distress Syndrome) and Multiorgan Failure
(MOF). The methods available for its implementation are
diverse and continually being developed. Continuous
Venovenous Hemofiltration allows a steady and rapid blood
flow which ensures a greater ultrafiltration rate. The
latter could be, as some authors state, directly related
with the survival of some critical care patients on CRRT
(eg. septic shock patients).
These therapies largely depend on nurse team skills and
obviously require specific preparation and continuous
care.
We will address and discuss the present possible
applications and tools of CRRT. We will also present,
briefly, the most frequent complications and the
necessary pharmacological adaptations.
Keywords: continuous renal replacement therapy,
venovenous hemofiltration, venovenous hemodiafiltration,
arteriovenous hemofiltration, arteriovenous
hemodiafiltration, acute renal failure, multiorgan
failure.
Cerebral salt wasting syndrome: a case report
Manuela Fera, Rosa Mendes, João Alcântara, Rui Sérgio, Resina Rodrigues
Summary:
Hyponatremia is frequently seen in neurosurgical patients
and is often attributed to inappropriate secretion of
antidiuretic hormone. A number of studies in recent years
have shown that hyponatremia in many patients with
intracranial disease may actually be caused by cerebral
salt wasting, in which a renal loss of sodium leads to
hyponatremia and a decrease in extracellular fluid
volume. The appropriate treatment of cerebral salt
wasting, (fluid and salt replacement), is opposite from
the usual treatment of hyponatremia caused by
inappropriate secretion of antidiuretic hormone.
The authors have made a review of the most recent
published literature about cerebral salt wasting
syndrome.
Keywords: Neurologic disease, polyuria,
natriuresis, hyponatremia, SIADH, CSW.
Vasodilators in pediatric septic shock: a case report
Augusto Ribeiro, Dulce Rainho, Filipe Almeida, José Aparício, Teresa Cunha Mota, José Carvalho, Emídio Carreiro, L. Almeida Santos
Summary:
Septic shock continues to be a serious clinical process
with a high mortality and morbidity rate, in spite of the
recent advances in the understanding of the it´s
pathogenesis, pathophysiology and new therapeutic
strategies.
Treatment with vasodilator drugs may be required if
tissue perfusion continues to decrease despite adequate
volume resuscitation and appropriate vasopressor therapy.
A case report of a child with acute lymphoblastic
leukemia who had septic shock caused by Escherichia Coli
in which we have used a continuous perfusion of
nitroglycerin, is presented. The authors also describe
their experience in the use of vasoactive drugs, namely
vasodilators, in these kind of situations.
Keywords: Pediatric septic shock, acute
lymphoblastic leukemia, vasoactive drugs, vasodilators.
Respiratory failure after continuos infusion of tramadol: a case report
Teresa Fontinhas, Luísa Gonçalves, Alexandre Carrilho
Summary:
The authors relate a clinical case of Pancreatitis with a
respiratory depression after continuous infusion of
tramadol. They review the possible causes, as well as
similar cases existing in international publications.
Keywords: Tramadol; Continuous infusion;
Respiratory depression.
| Creation date: 2
July 1998 Last update: 2 July 1998 |
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