Showing papers by "Carlos Roberto Ribeiro de Carvalho published in 2004"

Imbalances in regional lung ventilation: a validation study on electrical impedance tomography.

Abstract: Imbalances in regional lung ventilation, with gravity-dependent collapse and overdistention of nondependent zones, are likely associated to ventilator-induced lung injury Electric impedance tomography is a new imaging technique that is potentially capable of monitoring those imbalances The aim of this study was to validate electrical impedance tomography measurements of ventilation distribution, by comparison with dynamic computerized tomography in a heterogeneous population of critically ill patients under mechanical ventilation Multiple scans with both devices were collected during slow-inflation breaths Six repeated breaths were monitored by impedance tomography, showing acceptable reproducibility We observed acceptable agreement between both technologies in detecting right-left ventilation imbalances (bias = 0% and limits of agreement = -10 to +10%) Relative distribution of ventilation into regions or layers representing one-fourth of the thoracic section could also be assessed with good precision Depending on electrode positioning, impedance tomography slightly overestimated ventilation imbalances along gravitational axis Ventilation was gravitationally dependent in all patients, with some transient blockages in dependent regions synchronously detected by both scanning techniques Among variables derived from computerized tomography, changes in absolute air content best explained the integral of impedance changes inside regions of interest (r(2) > or = 092) Impedance tomography can reliably assess ventilation distribution during mechanical ventilation

Pulmonary and mediastinal sarcoidosis following surgical resection of cancer

Abstract: Previous reports indicate that enlarged hilar and mediastinal lymph nodes caused by sarcoid-like reactions may develop after curative resection of cancer, and their presence does not necessarily denote neoplastic recurrence. Reports further suggest that coexisting pulmonary infiltrates in this setting may be related to sarcoidosis. In this study, we describe two patients who had resected lung and gastric cancer and who later developed pulmonary interstitial infiltrate, concurrent with progressive mediastinal lymphadenopathy initially thought to be caused by intrathoracic dissemination of their cancer. These changes were shown by open lung biopsy to be a benign, granulomatous reaction interpreted as sarcoidosis. Thus, it is important to recognize this clinical pattern when pulmonary infiltrates develop after complete treatment of cancer in an otherwise relapse-free patient and to encourage lung or lymph node biopsy in these particular settings in order to confirm a sarcoid-like reaction, thereby avoiding unnecessary chemotherapy for presumed tumor recurrence.

Lesão por inalação de fumaça* Smoke inhalation injury

Abstract: A lesao inalatoria e hoje a principal causa de morte nos pacientes queimados, motivo pelo qual se justifica o grande numero de estudos publicados sobre o assunto. Os mecanismos envolvidos na genese da lesao inalatoria envolvem tanto os fatores de acao local quanto os de acao sistemica, o que acaba por aumentar muito as repercussoes da lesao. Atualmente, buscam-se ferramentas que permitam o diagnostico cada vez mais precoce da lesao inalatoria e ainda estrategias de tratamento que minimizem as consequencias da lesao ja instalada. Esta revisao aborda os mecanismos fisiopatologicos, os metodos diagnosticos e as estrategias de tratamento dos pacientes vitimas de lesao inalatoria. Ressalta ainda as perspectivas terapeuticas em desenvolvimento.

Forma grave da síndrome pulmonar e cardiovascular por hantavírus tratada com pressurização positiva através de máscara facial

Abstract: In 1993 the first Brazilian cluster of Hantavirus Cardiopulmonary Syndrome (HCPS) was described in Juquitiba, SP. Since then, there have been descriptions of new cases specially on the southeast and south states of Brazil. Only in 2002 there were observed the first three cases of HCPS in our city: Sao Carlos. One of our patients was successfully supported with CPAP through facial mask. This is the first severe case of acute respiratory failure induced by Hantavirus that was successfully managed with this kind of respiratory strategy.