Noninvasive Positive-Pressure Ventilation in Patients with Acute Hypoxemic Respiratory Failure and HIV/AIDS
Pulmonary complications, especially acute respiratory failure (ARF), contribute to morbidity and mortality in immunocompromised patients. The etiology, pathophysiology, and reversibility of lung injury and the severity of ARF are key to the therapeutic re
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N. Egea, A. Cazaux, M. Langer, and H. Cambursano
Keywords
Noninvasive ventilation • Acute hypoxemic respiratory failure • Hypoxemic respiratory failure • Respiratory failure in HIV/AIDS • NIV • NIPPV
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Introduction
Pulmonary complications, especially acute respiratory failure (ARF), contribute to morbidity and mortality in immunocompromised patients. The etiology, pathophysiology, and reversibility of lung injury and the severity of ARF are key to the therapeutic response and prognosis for these patients. An essential notion is that evolution of ARF depends on a causal disease and that noninvasive ventilation (NIV) does not correct the primary process. It should be considered a measure that allows us to gain the time needed to reverse the primary process. The longer NIV is needed, the less chance there is of success, suggesting that perhaps that patient is not an appropriate one to subject to NIV. It is advisable to identify the various scenarios in which immunosuppression may be associated with ARF.
N. Egea, MD (*) Hospital Rawson, Córdoba, Argentina e-mail: [email protected] A. Cazaux, MD • H. Cambursano, MD Hospital Rawson, Centro Dr Lázaro Langer, Córdoba, Argentina e-mail: [email protected]; [email protected] M. Langer, MD Centro Dr Lázaro Langer, Córdoba, Argentina e-mail: [email protected] A.M. Esquinas (ed.), Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events, DOI 10.1007/978-3-7091-1496-4_10, © Springer-Verlag Wien 2014
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• Patients with a malignancy or inflammatory diseases, among whom we can identify two groups: (1) those on immunosuppressive therapy, in whom ARF is mainly associated with infections, recurrence of the underlying disease, drug toxicity, or other noninfectious diseases; (2) those without immunosuppressive therapy, among whom ARF is predominantly related to progression of the underlying disease or other noninfectious disease. • Transplant patients with predominantly infectious pulmonary complications related to drug immunosuppression, drug toxicity, or other noninfectious diseases. • Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/ AIDS) patients, among whom ARF is related predominantly to lung infections (bacterial pneumonia, Pneumocystis jirovecii pneumonia, lung infections caused by opportunistic agents other than P. jirovecii) or other noninfectious diseases. In HIV/AIDS patients, ARF is the leading cause of hospitalization in intensive care units (ICUs), with bacterial pneumonia and P. jirovecii pneumonia the most frequently associated entities. Survival in this situation depends on having the means to diagnose and manage ARF and the causal disease and the methods to support vital functions (including respiratory function) while the causative disease is being reversed. Support of respiratory function might include the use of oxygen therapy, noninvasive positive-pressure ventilation (NIV), intubation and mechanical ventilation (MV), and/or extracorporeal oxygenation devices. Alt
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