Đang chuẩn bị liên kết để tải về tài liệu:
Non-pulmonary Critical Care - part 9

Không đóng trình duyệt đến khi xuất hiện nút TẢI XUỐNG Tải xuống

Trong phương pháp chẩn đoán của chúng tôi để bệnh nhân với IPS nghi ngờ, chúng tôi thực hiện BAL và, nếu không có chống chỉ định, transbronchial phổi sinh thiết. Chúng tôi tiến hành sinh thiết phổi video hỗ trợ thoracoscopic nếu transbronchial phổi sinh thiết là chống chỉ định | COMPLICATIONS FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANTATION AFESSA PETERS 303 of the patients are on antibiotics at the time of diagnosis.77 Infection is excluded by the absence of a pathogen in BAL fluid and by the lack of clinical response to antimicrobial therapy. DAH and perien-graftment respiratory distress syndrome PERDS also fulfill the diagnostic criteria of IPS.78 79 Despite overlap in the clinical features of IPS DAH and PERDS their responses to treatment and clinical courses are different.78 In our diagnostic approach to patients with suspected IPS we perform BAL and if there are no contraindications transbronchial lung biopsy. We proceed to video-assisted thoracoscopic lung biopsy if transbronchial lung biopsy is contraindicated or if the transbronchial specimen is inadequate. Lung biopsies of patients with IPS may show diffuse alveolar damage organizing or acute pneumonia and interstitial lymphocytic inflammation.77 80 TREATMENT There have been no randomized clinical trials addressing the treatment of IPS. Despite case reports of patients with IPS responding to treatment with corticosteroids studies with larger sample sizes have not shown any outcome benefit.7 1 Currently management consists of supportive care and prevention and treatment of infection. There is a report of three cases of HSCT recipients with IPS whose lung function improved following the administration of etanercept.76 This observation awaits further confirmation by clinical trial. CLINICAL COURSE AND PROGNOSIS The clinical course of HSCT recipients with IPS is usually complicated by viral and fungal infections as well as pneumothorax pneumomediastinum subcutaneous emphysema pulmonary fibrosis and autoimmune polyserositis.13 The overall mortality of IPS is 74 with a reported range between 60 and 86 .13 The 1 year survival rate is less than 15 .77 81 For those who require mechanical ventilation the hospital mortality exceeds 95 .77 Diffuse Alveolar Hemorrhage EPIDEMIOLOGY DAH .