未经证实:缺乏急性呼吸窘迫综合征(ARDS)的诊断涉及20%的癌症患者,并与较差的预后相关。弥漫性肺炎型腺癌(P-ADC)是这些难以诊断的ARDS的一部分,但关于弥漫性P-ADC的危重患者的数据有限。我们试图描述入住重症监护病房(ICU)的P-ADC相关ARDS患者的诊断过程和预后。
UNASSIGNED:单中心观察性病例系列研究。包括所有连续两个十年内入住ICU的患者,这些患者均患有(I)经组织学或细胞学证实的肺腺癌和(II)符合柏林定义的ARDS。临床,生物,收集P-ADC的放射学和细胞学特征以确定诊断线索.进行了多因素logistic回归分析,以评估与ICU和医院死亡率相关的因素。
未经授权:在24名患者中[70(61-75)岁,17(71%)男性],在19(79%)的ICU住院期间进行了癌症诊断,17(71%)需要机械通气。首发症状与P-ADC诊断之间的时间为210天(92-246天)。在ICU入院时血浆C反应蛋白水平为34mg/L(19至75mg/L)的23(96%)患者中观察到2(2至3)抗生素品行后未解决的肺炎。进行性呼吸困难,支气管溢,咸咳痰,裂隙膨出和压缩的支气管和血管存在于100%,83%,69%,57%和43%的病例。痰或支气管肺泡灌洗液的细胞学检查可提供75%的诊断率。ICU和医院死亡率分别为25%和63%,分别。首次出现症状和诊断之间的时间(以天为单位)[比值比(OR)1.02,95%置信区间(95%CI):1.00-1.03,P=0.046]和简化急性生理评分II(OR1.16,95%CI:1.01-1.33,P=0.040)与ICU死亡率独立相关。
未经评估:几种抗生素治疗后出现未缓解的肺炎,无炎症综合征,与进行性呼吸困难相关,咸支气管溢,和大叶肿胀(即,裂隙鼓胀,压缩支气管和血管)提示P-ADC。弥漫性P-ADC的延迟诊断似乎是独立的预后预测因子,及时识别疾病可能有助于改善预后。
UNASSIGNED: The absence of diagnosis of acute respiratory distress syndrome (ARDS) concerns 20% of cancer patients and is associated with poorer outcomes. Diffuse pneumonic-type adenocarcinoma (P-ADC) is part of these difficult-to-diagnose ARDS, but only limited data are available regarding critically ill patients with diffuse P-ADC. We sought to describe the diagnosis process and the prognosis of P-ADC related ARDS patients admitted to the intensive care unit (ICU).
UNASSIGNED: Single-center observational
case series study. All consecutive patients admitted to the ICU over a two-decade period presenting with (I) histologically or cytologically proven adenocarcinoma of the lung and (II) ARDS according to Berlin definition were included. Clinical, biological, radiological and cytological features of P-ADC were collected to identify diagnostic clues. Multivariate logistic regression analyses were performed to assess factors associated with ICU and hospital mortality.
UNASSIGNED: Among the 24 patients included [70 (61-75) years old, 17 (71%) males], the cancer diagnosis was performed during the ICU stay in 19 (79%), and 17 (71%) required mechanical ventilation. The time between the first symptoms and the diagnosis of P-ADC was 210 days (92-246 days). A non-resolving pneumonia after 2 (2 to 3) antibiotics lines observed in 23 (96%) patients with a 34 mg/L (19 to 75 mg/L) plasma C-reactive protein level at ICU admission. Progressive dyspnea, bronchorrhea, salty expectoration, fissural bulging and compressed bronchi and vessels were present in 100%, 83%, 69%, 57% and 43% of cases. Cytological examination of sputum or broncho-alveolar lavage provided a 75% diagnostic yield. The ICU and hospital mortality rates were 25% and 63%, respectively. The time (in days) between first symptoms and diagnosis [odds ratio (OR) 1.02, 95% confidence interval (95% CI): 1.00-1.03, P=0.046] and the Simplified Acute Physiology Score II (OR 1.16, 95% CI: 1.01-1.33, P=0.040) were independently associated with ICU mortality.
UNASSIGNED: Non-resolving pneumonia after several antibiotics lines without inflammatory syndrome, associated with progressive dyspnea, salty bronchorrhea, and lobar swelling (i.e., fissural bulging, compressed bronchi and vessels) were suggestive of P-ADC. Delayed diagnosis of diffuse P-ADC seemed an independent prognostic predictor and disease timely recognition may contribute to prognosis improvement.