Precisão do diagnóstico clínico da síndrome do desconforto respiratório agudo quando comparado a achados de necropsia

Pinheiro, Bruno Valle; Muraoka, Fabiana Sayuri; Assis, Raimunda Violante Campos de; Lamin, Raul Fernando Binato; Pinto, Sérgio Paulo dos Santos; Júnior, Paulo Justiniano Ribeiro; Oliveira, Júlio César Abreu de

doi:10.1590/s1806-37132007000400011

Cited by 30 publications

(6 citation statements)

References 13 publications

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“…Other studies have described similar findings and reported BBP as the most common disease in ARF patients. 20,[23][24][25] Gross et al 25 analyzed 234 autopsies of elderly patients and found that 33% of them had BBP, which is exactly the same prevalence observed in our study but in an elderly-only population. 25 Cancer was the second most important complication diagnosis in our study; it was present in 28.1% of the autopsies.…”

Section: Discussionsupporting

confidence: 88%

“…Infectious diseases were the most common diagnoses, as has also been described by other authors. 6,9,[14][15][16][17][18][19][20]23,24 Interestingly, these findings are not consistent with our previously published study in 2008 that reported related cases of ARF in autopsies from 1990 to 2000 only; it reported the following associated diseases or complications in descending order: HIV/AIDS (31.4%), BBP (21.8%), sepsis and septic shock (11.7%), liver cirrhosis (11.5%), pulmonary embolism (5.7%), acute myocardial infarction (5.5%), brain stroke (4.6%), tuberculosis (3.6%), cancer (2.3%), chronic kidney failure (1.9%), and leukemia (0.2%). 22 BBP was present in 33.9% of the patients and was the most frequent pulmonary complication found during autopsy.…”

Section: Discussionmentioning

confidence: 99%

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

Soeiro

Ruppert

Canzian

et al. 2011

Clinics

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INTRODUCTION:Acute respiratory failure has been one of the most important causes of death in intensive care units, and certain aspects of its pulmonary pathology are currently unknown.OBJECTIVES:The objective was to describe the demographic data, etiology, and pulmonary histopathological findings of different diseases in the autopsies of patients with acute respiratory failure.METHOD:Autopsies of 4,710 patients with acute respiratory failure from 1990 to 2008 were reviewed, and the following data were obtained: age, sex, and major associated diseases. The pulmonary histopathology was categorized as diffuse alveolar damage, pulmonary edema, alveolar hemorrhage, and lymphoplasmacytic interstitial pneumonia. The odds ratio of the concordance between the major associated diseases and specific autopsy findings was calculated using logistic regression.RESULTS:Bacterial bronchopneumonia was present in 33.9% of the cases and cancer in 28.1%. The pulmonary histopathology showed diffuse alveolar damage in 40.7% (1,917) of the cases. A multivariate analysis showed a significant and powerful association between diffuse alveolar damage and bronchopneumonia, HIV/AIDS, sepsis, and septic shock, between liver cirrhosis and pulmonary embolism, between pulmonary edema and acute myocardial infarction, between dilated cardiomyopathy and cancer, between alveolar hemorrhage and bronchopneumonia and pulmonary embolism, and between lymphoplasmacytic interstitial pneumonia and HIV/AIDS and liver cirrhosis.CONCLUSIONS:Bronchopneumonia was the most common diagnosis in these cases. The most prevalent pulmonary histopathological pattern was diffuse alveolar damage, which was associated with different inflammatory conditions. Further studies are necessary to elucidate the complete pathophysiological mechanisms involved with each disease and the development of acute respiratory failure.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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

Soeiro

Ruppert

Canzian

et al. 2011

Clinics

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“…Observational studies showed that a diagnosis of ARDS is registered in the clinical records of only 30% to 50% of individuals who were shown to have diffuse alveolar injury on autopsy. (165-167) For this reason, special attention to the possible presence of ARDS in patients with sepsis has paramount importance. Some interventions have proven efficacy in patients with ARDS, such as ventilation with Vt between 4 to 6mL/kg of predicted body weight.…”

Section: Mechanical Ventilation In Patients With Sepsismentioning

confidence: 99%

Brazilian recommendations of mechanical ventilation 2013. Part I

Barbas¹,

Isola²,

Farias³

et al. 2014

Revista Brasileira De Terapia Intensiva

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Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

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“…(5) It has been well known for many years that DAD is present in only half of autopsies from patients with ARDS. (6,7) However, the recent demonstration that the same proportion occurs in living patients, (8) as well as the effect that DAD exerts over ARDS outcome, shine a new light on this entity. (9-11) …”

Section: Introductionmentioning

confidence: 99%

What every intensivist should know about acute respiratory distress syndrome and diffuse alveolar damage

Ríos

Iscar

Cardinal-Fernández

2017

Revista Brasileira De Terapia Intensiva

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Acute respiratory distress syndrome is a challenging entity for the intensivist. The pathological hallmark of the acute phase is diffuse alveolar damage, which is present in approximately half of living patients with acute respiratory distress syndrome. It is clear that respiratory support for acute respiratory distress syndrome has gradually been improving over recent decades. However, it is also evident that these procedures are beneficial, as they reduce lung injury and keep the patient alive. This could be interpreted as a time-gaining strategy until the trigger or causal or risk factor improves, the inflammatory storm decreases and the lung heals. However, all except two pharmacological treatments (neuromuscular blockers and steroids) were unable to improve the acute respiratory distress syndrome outcome. The hypothesis that pharmacological negative results may be explained by the histological heterogeneity of acute respiratory distress syndrome has been supported by the recent demonstration that acute respiratory distress syndrome with diffuse alveolar damage constitutes a specific clinical-pathological entity. Given that diffuse alveolar damage is a pathological diagnosis and that open lung biopsy (the most common technique to obtain lung tissue) has several side effects, it is necessary to develop surrogate biomarkers for diffuse alveolar damage. The aim of this narrative review is to address the following three topics related to acute respiratory distress syndrome: (a) the relationship between acute respiratory distress syndrome and diffuse alveolar damage, (b) how diffuse alveolar damage could be surrogated in the clinical setting and (c) how enrichment in diffuse alveolar damage may improve the results of pharmacological clinical trials tried out on patients with acute respiratory distress syndrome.

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Precisão do diagnóstico clínico da síndrome do desconforto respiratório agudo quando comparado a achados de necropsia

Abstract: The accuracy of the AECC definition of ARDS was godless than satisfactory. Due to the low positive predictive value and the low positive likelihood ratio, other hypotheses must be considered when ARDS is suspected.

Cited by 30 publications

References 13 publications

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

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

Brazilian recommendations of mechanical ventilation 2013. Part I

What every intensivist should know about acute respiratory distress syndrome and diffuse alveolar damage

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