Pneumologia
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Browsing Pneumologia by Subject "Aged"
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- Broncho-Esophageal Fistula: When Surgery and Endoscopy Fail, Consider Physiological Lung ExclusionPublication . Maia, D; Tronchetti, J; D'Journo, X; Dutau, HWe discuss the case of an esophageal cancer patient treated by chemo and radiotherapy complicated by an esophageal stenosis and an iatrogenic broncho-esophageal fistula. This latter was managed with multiple palliative stenting procedures and colonic surgical bypass. Despite a long disease free survival but decreased quality of life and frailty, we came to the proposal of an extremely unusual form of treatment - physiological lung exclusion, with clinical benefit and so far without any drawbacks related to the procedure.
- A Diagnosis Hard to SwallowPublication . Maia, D; Caires, N; Silva, S
- Validity of a Clinical Scale in Predicting the Failure of Non-Invasive Ventilation in Hypoxemic PatientsPublication . Carrillo, A; Lopez, A; Carrillo, L; Caldeira, V; Guia, M; Alonso, N; Renedo, A; Quintana, M; Sanchez, J; Esquinas, AIntroduction: The HACOR scale is a clinical score that can predict early failure of NIV in hypoxemic acute respiratory failure (ARF) The aim of this study is to analyze the validity of the HACOR scale. Methods: A retrospective study of a cohort of over 2749 episodes on 2711 consecutive patients requiring NIV for hypoxemic ARF in a polyvalent intensive care unit. The scale was measured before starting NIV and at 1, 6, 12, 24 and 48 h after the initiation of NIV. Results: NIV failure occurred in 963 patients (35%). The value of the HACOR scale before NIV did not differ between success and failure. However, at 1, 6, 12, 24 and 48 h of NIV, the scale values clearly differed between the two groups. The HACOR scale at NIV initiation accurately predicts NIV failure in the first hour, with an optimal cut-off value of 8 points. The AUC for predicting NIV failure with HACOR at 1 h is greater than 0.9 in patients with pneumonia and adult respiratory distress syndrome (ARDS). Conclusions: The HACOR scale measured at 1 h after NIV initiation accurately predicts NIV failure, especially in pneumonia and ARDS.