REVIEWS

Therapeutic principles in the acute respiratory distress syndrome – the concept of “protective mechanical ventilation”

Anca Macri, Radu Stoica
Therapeutic principles in the acute respiratory distress syndrome – the concept of “protective mechanical ventilation” The adult respiratory distress syndrome (ARDS) represents a very severe form of acute respiratory failure which is underlain by lesional (noncardiogenic) lung edema and is defined by a series of clinical, imaging, hemodynamic and oxygenation criteria. Most cases need rapidly established invasive ventilatory support, preferably, in intensive care units with expertise in the care of these patients. Even with the appropriate therapy, the prognosis is unfavourable, and mortality is high. Protective mechanical ventilation is a complex concept based on the existence of multiple areas with different degrees of lung damage; it is meant to maintain acceptable gaseous exchanges (permissive hypoxemia and hypercapnia) by reducing the risk of trauma through mechanical ventilation. The protective mechanical ventilation strategies reduce complications and mortality. The alveolar recruitment manoeuvres and techniques for keeping the recruited areas open by using positive end-expiratory pressure (PEEP) and the prone-position ventilation (ventral decubitus) are extremely important and with proved results. Other methods addressing the gaseous exchanges may improve oxygenation but not also mortality. General supporting measures and complications prevention are part of the complex therapeutic approach of these cases.

Therapeutic principles in the acute respiratory distress syndrome – the concept of “protective mechanical ventilation”

Alveolar haemorrhage syndrome – a rare side effect during some frequently used therapies

Alina Valentina Dobrota, Aneta Șerbescu, Alina Croitoru, Bianca Paraschiv, Alexandru Miron Bogdan,Claudia Toma
Alveolar haemorrhage syndrome – a rare side effect during some frequently used therapies Alveolar haemorrhage syndrome is a serious condition with deadly potential and with a variety of etiology: autoimmune diseases associated with vasculitis, infectious, idiopathic, drug-induced or following exposure to toxic substances, in the context of cardiac disease, coagulation disorders or secondary to bone marrow transplant or organ transplant. Clinically, it manifests with dyspnea, fever, cough and haemoptysis, the paraclinical manifestations being acute hypoxemic respiratory failure, anemic and radiological syndrome with the occurrence of diffuse pulmonary infiltrate. The diagnosis remains one of exclusion, requiring a series of additional tests depending on the etiological suspicion. The confirmation is obtained by bronchoscopy with bronchoalveolar lavage, a haemorrhagic lavage fluid with increased erythrophage content being the sign of alveolar haemorrhage, and the severity of bleeding is assessed by the Golde score. If the etiology is uncertain, the pulmonary biopsy is indicated. The treatment is based on etiology, especially in case of drug etiology, and can be conservative, supportive, with discontinuation of the incriminated drug. Corticoids and immunosuppressants are administered, especially when vasculitis phenomena are associated. Considering the severity of clinical manifestations and their consequences, alveolar haemorrhage syndrome is always a diagnostic and therapeutic emergency irrespective of the mechanism of production. This article reviews the various medications commonly used in medical practice which may have an alveolar haemorrhage syndrome as adverse reaction, produced by various mechanisms.

Alveolar haemorrhage syndrome – a rare side effect during some frequently used therapies

Ultrasound-guided percutaneous pleural and lung biopsy

Gabriela Jimborean, Edith Simona Ianoşi, Alpar Csipor, Tudor P. Toma
Ultrasound-guided percutaneous pleural and lung biopsy Pleural biopsy, or lung biopsy, is recommended for the diagnosis of pleural and subpleural lung abnormalities (primary or secondary malignant tumor, tuberculosis, collagen disease, pachipleuritis, sarcoidosis etc.). There are several biopsy techniques: closed needle pleural biopsy, image-guided (thoracic ultrasound or computerized tomography) needle biopsy, and biopsy by thoracoscopy or open lung surgery. The continuous development in the recent years of the use of thoracic ultrasound (TUS) has improved the technique and the results of the pleural and lung biopsy. Ultrasound-guided pleural, or lung needle biopsy (USPLB), is a safe and minimal invasive real-time technique with less complications than CT-guided biopsy. USPLB may provide adequate tissue sampling of lesions for cytology/ histology/ immunohistochemistry or bacteriology. At the same time, USPLB has a high diagnostic yield and is much more accessible and comfortable for patients and the physician than thoracoscopy. This review aims to summarize the key technical elements of ultrasound-guided pleural and lung biopsies, in order to promote the development of these techniques in Romania.

Ultrasound-guided percutaneous pleural and lung biopsy