Impacto de biópsia pulmonar a céu aberto na insuficiência respiratória aguda refratária

Abstract

RESUMOObjetivo: Verificar o impacto dos resultados da biópsia pulmonar a céu aberto nas decisões que determinem mudanças nas estratégias de tratamento de pacientes críticos, com infiltrados pulmonares difusos e insuficiência respiratória aguda refratária, bem como na melhora de seu quadro clínico. Métodos: Foram avaliados 12 pacientes com insuficiência respiratória aguda e sob ventilação mecânica, que foram submetidos à biópsia pulmonar a céu aberto (por toracotomia) após a ausência de resposta clínica ao tratamento padrão. Resultados:A maior causa isolada de insuficiência respiratória aguda foi a infecção viral, identificada em 5 pacientes (40%). A avaliação pré-operatória da causa da insuficiência respiratória foi modificada em 11 pacientes (91,6%), e um diagnóstico específico foi feito em 100% dos casos. A taxa de mortalidade foi de 50%, a despeito das mudanças no regime terapêutico. Seis pacientes (50%) sobreviveram e obtiveram alta hospitalar. Todos os pacientes que obtiveram alta sobreviveram por pelo menos um ano após a biópsia pulmonar a céu aberto, totalizando uma taxa de sobrevida em um ano de 50% dentre os 12 pacientes estudados. Quanto aos pacientes que faleceram no hospital, o tempo de sobrevida após a biópsia pulmonar a céu aberto foi de 14 + 10,8 dias. Conclusão: Concluímos que a biópsia pulmonar a céu aberto é uma ferramenta útil no controle da insuficiência respiratória aguda quando não se observa melhora clínica após o tratamento padrão, já que pode resultar em um diagnóstico específico que requeira tratamento distinto, provavelmente diminuindo a taxa de mortalidade desses pacientes. The single most common cause of the acute respiratory failure was viral infection, which was identified in 5 patients (40%). The preoperative evaluation of the cause of respiratory failure was modified in 11 patients (91.6%), and a specific diagnosis was made in 100% of the cases. Regardless of changes in treatment regimen, the mortality rate was 50%. Six patients (50%) survived to be discharged from the hospital. All of the discharged patients survived for at least one year after the open lung biopsy, for an overall one-year survival rate of 50% among the 12 patients studied. For the patients who died in the hospital, the time of survival after open lung biopsy was 14 + 10.8 days. Conclusion: We conclude that open lung biopsy is a useful tool in the management of acute respiratory failure when there is no clinical improvement after standard treatment, since it can lead to a specific diagnosis that requires distinct treatment, which probably lowers the mortality rate among such patients.

Postmortem diagnosis of acute myocardial infarction in patients with acute respiratory failure - demographics, etiologic and pulmonary histologic analysis

“…The diagnosis of ARF was made based on the clinical description and/or death certificate and defined as a PaO2<60 mmHg or PaCO2>50 mmHg with pH<7.30 while breathing room air (1-3). We excluded patients younger than one year of age because of the possibility of congenital heart diseases and hyaline membrane disease.…”

“…Acute respiratory failure (ARF) is a major cause of death in patients with a variety of primary underlying diseases (1-4). The clinical and radiographic findings of ARF are nonspecific (5-7).…”

Demographic, etiological, and histological pulmonary analysis of patients with acute respiratory failure: a study of 19 years of autopsies

“…The only inclusion criterion for the definition of ARF was based on arterial blood gases (PaO2,60 mmHg or PaCO2.50 mmHg with pH,7.30) while breathing room air. [1][2][3] We excluded patients younger than one year of age and individuals not diagnosed with ARF.…”

“…In addition, the prevalences of comorbidities and mortality have been reported to be higher than 40-50% in ARF patients, especially in those with diffuse infiltrates as seen on chest X-rays. [1][2][3] The clinical and radiological findings in ARF are nonspecific, [4][5][6] and prompt investigation and diagnosis are essential to improving patient survival. [7][8][9] In this context, the complexity of clinical presentations makes diagnosis a constant challenge for the clinician.…”

Alterações histopatológicas pulmonares em pacientes com insuficiência respiratória aguda: um estudo em autopsias

“…(9) However, recent studies have demonstrated the value of autopsy in medical education, in the evaluation of medical procedures, in physiopathology, in epidemiology, in public health and in the evaluation of the treatment employed. (1,(6)(7)(8)10,11,(26)(27)(28)(29) Nevertheless, and specifically in pediatrics, autopsy can detect genetic diseases, allowing better counseling of the family. (7,9) Regarding issues such as whether to take into account the value of autopsy in medical education and medical procedures, and considering that many of the postmortem findings might have influenced treatment during the life of the patient and prevented the death of other patients, our study has limitations.…”