Rev Port Pneumol
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Bronchoalveolar lavage (BAL) with quantitative cultures has been used in order to increase ventilator associated pneumonia (VAP) diagnosis specificity, although the accurate technique for this entity diagnosis remains controversial. ⋯ In late onset VAP, positive BAL and quantitative cultures allowed therapeutic changes, leading to antibiotic adequacy and consumption reduction, which can however be maximised.
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Epipericardial fat necrosis is an uncommon benign entity of unknown cause, with only 20 cases reported in the English-language literature. It should be remembered as a possible diagnosis in a person who presents with acute pleuritic chest pain and paracardiac density or pleural effusion on chest radiography (X-ray). The computed tomography (CT) or surgical approach allows the final diagnosis and characterization. ⋯ This made the diagnosis of epipericardial fat necrosis. During hospitalization the patient remained stable and was discharged home with symptomatic relieve therapy. Because of benign, self-limited nature of this entity, only conservative treatment is indicated.
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Non-invasive ventilation (NIV) is a technique that delivers mechanical ventilation avoiding side effects and complications associated with endotracheal intubation and invasive mechanical ventilation. This technique has proved to be effective in different types of respiratory failure. In this article, the authors revise the advantages and limitations of NIV, interfaces used and indications in acute and acute-on-chronic respiratory failure.
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While open lung biopsy (OLB) performed in patients on mechanical ventilation (MV) with diffuse lung diseases (DLD) can be extremely important in establishing the diagnosis, the associated risk of this procedure should be taken into account. ⋯ The high diagnostic yield and the low incidence of complications make OLB a useful procedure in patients on MV with DLD of unknown aetiology. However, early OLB may lead to even better results in some patients.
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Negative pressure pulmonary oedema is an uncommon complication of traqueal extubation (approximately 0,1%) mostly caused by acute upper airway obstruction. Upper airway obstruction from glottis closure leads to marked inspiratory effort, which generates negative intrathoracic pressure transmitting to pulmonary interstitium, and inducing fluid transudation from pulmonary capillary bed(1-5). We report a case of post-extubation pulmonary oedema in a fifteen years old patient, submitted to surgery following traumatic amputation of his left leg. We review the pathophysiology, radiological findings, potential risk factors and preventive measures of this post-anaesthetic respiratory complication.