Artigo Original/Original Article
Biópsia pulmonar cirúrgica em doentes sob ventilação invasiva e com suspeita de doença difusa do parênquima pulmonar
Open lung biopsy in patients on mechanical ventilation with suspected diffuse lung disease
Natália Melo1,
, Sandra Figueiredo1, António Morais2, Conceição Souto Moura3, Paulo Pinho4, Pedro Bastos5, Teresa Oliveira6
Corresponding author
nataliafmelo@hotmail.com
Correspondência/Correspondence to: Natália Melo Serviço de Pneumologia Hospital de S. João Alameda Professor Hernâni Monteiro 4202-451 Porto, Telefone: 919371855.
Correspondência/Correspondence to: Natália Melo Serviço de Pneumologia Hospital de S. João Alameda Professor Hernâni Monteiro 4202-451 Porto, Telefone: 919371855.
1 Interna Complementar de Pneumologia/Resident, Pulmonology, Serviço de Pneumologia do H.S.João – Director de Serviço: Prof. Dr. Venceslau Hespanhol/Pulmonology Unit, H. S. João, Porto – Unit Director: Prof. Dr. Venceslau Hespanhol
2 Assistente Hospitalar de Pneumologia/Consultant Pulmonology Serviço de Pneumologia do H.S.João – Director de Serviço: Prof. Dr. Venceslau Hespanhol/Pulmonology Unit, H. S. João, Porto – Unit Director: Prof. Dr. Venceslau Hespanhol
3 Assistente Hospitalar Graduada de Anatomia Patológica – Serviço de Anatomia Patológica do H. S. João – Directora de Serviço: Prof. Dra. Fátima Carneiro/Consultant, Specialist, Anatomical Pathology – Anatomical Pathology Unit, H. S. João – Unit Director: Prof. Dr. Fátima Carneiro
4 Director de Serviço – Serviço de Cirurgia Cardiotorácica do Hospital de S. João/Unit Director, Cardiothoracic Surgery Unit, Hospital de S. João
5 Chefe de Serviço de Cirurgia Cardiotorácica – Serviço de Cirurgia Cardiotorácica do Hospital de S. João – Director de Serviço: Dr. Paulo Pinho/Unit Head, Cardiothoracic Surgery Unit, Hospital de S. João – Unit Director: Dr. Paulo Pinho
6 Assistente Hospitalar Graduada em Anestesiologia – Serviço de Cuidados Intensivos – Director de Serviço: Dra. Ana Maria Mota/Consultant, Specialist, Anesthesiology – Intensive Care Unit – Unit Director: Dr. Ana Maria Mota
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S. João, Porto – Unit Director: Prof. Dr. Venceslau Hespanhol" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Assistente Hospitalar de Pneumologia/<span class="elsevierStyleItalic">Consultant Pulmonology</span> Serviço de Pneumologia do H.S.João – Director de Serviço: Prof. Dr. Venceslau Hespanhol/Pulmonology Unit, H. S. João, Porto – Unit Director: Prof. Dr. Venceslau Hespanhol" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Assistente Hospitalar Graduada de Anatomia Patológica – Serviço de Anatomia Patológica do H. S. João – Directora de Serviço: Prof. Dra. Fátima Carneiro/Consultant, Specialist, Anatomical Pathology – Anatomical Pathology Unit, H. S. João – Unit Director: Prof. Dr. Fátima Carneiro" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Director de Serviço – Serviço de Cirurgia Cardiotorácica do Hospital de S. João/Unit Director, Cardiothoracic Surgery Unit, Hospital de S. João" "etiqueta" => "4" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Chefe de Serviço de Cirurgia Cardiotorácica – Serviço de Cirurgia Cardiotorácica do Hospital de S. João – Director de Serviço: Dr. Paulo Pinho/Unit Head, Cardiothoracic Surgery Unit, Hospital de S. João – Unit Director: Dr. Paulo Pinho" "etiqueta" => "5" "identificador" => "af0025" ] 5 => array:3 [ "entidad" => "Assistente Hospitalar Graduada em Anestesiologia – Serviço de Cuidados Intensivos – Director de Serviço: Dra. Ana Maria Mota/Consultant, Specialist, Anesthesiology – Intensive Care Unit – Unit Director: Dr. Ana Maria Mota" "etiqueta" => "6" "identificador" => "af0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleBold">Correspondência</span>/<span class="elsevierStyleBold">Correspondence to</span>: Natália Melo Serviço de Pneumologia Hospital de S. João Alameda Professor Hernâni Monteiro 4202-451 Porto, Telefone: 919371855." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Open lung biopsy in patients on mechanical ventilation with suspected diffuse lung disease" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-11-21" "fechaAceptado" => "2009-02-17" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570209" "palabras" => array:3 [ 0 => "Biópsia pulmonar cirúrgica" 1 => "ventilação invasiva" 2 => "infiltrados pulmonares difusos" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570208" "palabras" => array:3 [ 0 => "Open lung biopsy" 1 => "mechanical ventilation" 2 => "diffuse lung infiltrates" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdução:</span> A realização de biópsia pulmonar cirúrgica (BPC) em doentes sob ventilação invasiva (VI) no contexto de doenças difusas do pulmão (DPD) poderá revelar-se necessária em circunstâncias em que se torne fundamental a precisão diagnóstica, devendo obviamente ser ponderado o risco associado.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivo:</span> Avaliação da rentabilidade diagnóstica, alterações da orientação terapêutica, complicações e mortalidade em doentes com DPD sob VI, submetidos a BPC.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material e métodos:</span> Estudo retrospectivo de 19 doentes admitidos no Hospital de S. João, num período de 8,5 anos (Janeiro 1999 – Julho 2007). Foram analisados os dados demográficos, as variáveis ventilatórias antes e após a BPC, a rentabilidade diagnóstica e o seu efeito na mudança terapêutica e as complicações da BPC. Análise estatística efectuada com SPSS 14.0.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados:</span> A idade média dos doentes foi de 58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16,3 anos, e 53% eram do sexo masculino. A média de dias de internamento em unidade de cuidados intensivos (UCI) antes da realização da BPC foi de 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7 dias. Todas as biópsias foram efectuadas por toracotomia. A rentabilidade diagnóstica foi de 95%. Apenas 4 doentes (21%) apresentaram complicações deste procedimento (fuga aérea prolongada). A razão pressão parcial do oxigénio arterial/fracção de oxigénio inspirada (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span>) e a pressão expiratória final positiva (PEEP) antes e após a BPC não mostraram diferenças significativas. Em 14 doentes (74%) o resultado histológico obtido levou à alteração da suspeita de diagnóstico inicial, condicionando em 8 deles (42%) uma mudança da orientação terapêutica. A mortalidade global foi de 47% (9 doentes), não se tendo observado em nenhum deles relação com o procedimento.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusão:</span> A análise desta amostra sugere que a BPC poderá ser um procedimento de extrema utilidade em situações de diagnóstico indeterminado no contexto de doentes com DPD sob VI, para o que contribui a alta rentabilidade diagnóstica e a baixa incidência de complicações reveladas. Contudo, a realização mais precoce de BPC poderia, em alguns casos, originar resultados ainda mais significativos.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009; XV (4): 597-611</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Background:</span> 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.</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aim:</span> To determine the diagnostic yield, therapeutic changes, complications and mortality in patients with DLD on MV submitted to OLB.</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Methods:</span> Retrospective study of 19 patients admitted to S. João Hospital between January 1999 and July 2007 (8.5<span class="elsevierStyleHsp" style=""></span>years). Data analysed included demographic data, ventilation variables before and after biopsy, diagnostic yield, effect on subsequent treatment changes and complications of OLB. Statistical analysis was performed using SPSS 14.0.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results:</span> The mean age of patients was 58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.3<span class="elsevierStyleHsp" style=""></span>years old and 53% were male. The mean duration of hospital stay in Intensive Care Unit before performing OLB was 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>days. All biopsies were performed by thoracotomy. The diagnostic yield was 95%. There were no significant differences in partial pressure of arterial oxygen/fraction of inspired oxygen (PaO<span class="elsevierStyleInf">2</span>/ FiO<span class="elsevierStyleInf">2</span>) ratio and the positive end expiratory pressure (PEEP) before and after OLB. Postoperative complications occurred in 4 patients (21%; persistent air leak). Alteration in the diagnosis occurred in 14 patients (74%) and in 8 patients (42%) there was a modification in the treatment regimen. Global mortality was 47% (9 patients) but there were no biopsyrelated deaths.</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusion:</span> 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.</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009; XV (4): 597-611</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia/Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary diagnostic procedures in critically ill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.S. 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Article information
ISSN: 08732159Original language: Portuguese
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| 2016 June | 3 | 0 | 3 |
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