Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
Réanimation Polyvalente, Hôpital Victor Dupouy, 69 Rue du Lieutenant Colonel Prudhon, 95100, Argenteuil, France.
Lung. 2017 Aug;195(4):477-487. doi: 10.1007/s00408-017-0011-8. Epub 2017 Apr 28.
Diffuse alveolar hemorrhage (DAH) with negative-pressure pulmonary edema (NPPE) is an uncommon yet life-threatening condition. We aimed at describing the circumstances, clinical, radiological, and bronchoscopic features, as well as the outcome of patients with NPPE-related DAH.
We performed a retrospective, observational cohort study, using data prospectively collected over 35 years in an intensive care unit (ICU).
Of the 149 patients admitted for DAH, we identified 18 NPPE episodes in 15 patients, one admitted four times for recurrent NPPE-related DAH. The patients were primarily young, male, and athletic. The NPPE setting was postoperative (n = 12/18, 67%) or following generalized tonic-clonic seizures (n = 6/18, 33%). Hemoptysis was almost constant (n = 17/18, 94%), yet rarely massive (>200 cc, n = 1/18, 6%), with anemia observed in 10 (56%) episodes. The DAH triad (hemoptysis, anemia, and pulmonary infiltrates) was observed in 50% of episodes (n = 9/18), and acute respiratory failure in 94% (n = 17/18). Chest computed tomography revealed diffuse bilateral ground glass opacities (n = 10/10, 100%), while bronchoscopy detected bilateral hemorrhage (n = 12/12, 100%) and macroscopically bloody bronchoalveolar lavage, with siderophage absence in most (n = 7/8, 88%), indicating acute DAH. While one episode proved fatal, the other 17 recovered rapidly, with a mean ICU stay lasting 4.6 (2-15) days. Typically, the evolution was rapidly favorable under supportive care.
NPPE-related DAH is a rare life-threatening condition occurring primarily after tonic-clonic generalized seizure or generalized anesthesia. Clinical circumstances are a key to its diagnosis. Early diagnosis and recognition likely allow for successful management of this potentially serious complication, whereas ictal-DAH appears ominous in epileptic patients.
弥漫性肺泡出血（DAH）伴负压性肺水肿（NPPE）是一种罕见但危及生命的疾病。我们旨在描述与 NPPE 相关的 DAH 患者的情况、临床、放射学和支气管镜下特征以及结局。
我们进行了一项回顾性观察队列研究，使用 35 年来在重症监护病房（ICU）前瞻性收集的数据。
在 149 例 DAH 患者中，我们确定了 15 例患者中的 18 例 NPPE 发作，其中 1 例因复发性 NPPE 相关 DAH 入院 4 次。患者主要为年轻、男性和运动员。NPPE 发生在术后（n=12/18，67%）或全身性强直阵挛性癫痫发作后（n=6/18，33%）。咯血几乎是普遍存在的（n=17/18，94%），但很少大量（>200 cc，n=1/18，6%），10 例（56%）出现贫血。18 例中有 9 例（50%）出现 DAH 三联征（咯血、贫血和肺部浸润），17 例（94%）出现急性呼吸衰竭。胸部计算机断层扫描显示弥漫性双侧磨玻璃影（n=10/10，100%），而支气管镜检查显示双侧出血（n=12/12，100%）和大体上血性支气管肺泡灌洗，大多数（n=7/8，88%）中未见含铁血黄素细胞，表明急性 DAH。虽然有 1 例死亡，其余 17 例迅速恢复，平均 ICU 住院时间为 4.6（2-15）天。通常情况下，在支持性治疗下，病情迅速好转。
NPPE 相关的 DAH 是一种罕见的危及生命的疾病，主要发生在全身性强直阵挛性癫痫发作或全身麻醉后。临床情况是其诊断的关键。早期诊断和识别可能有助于成功治疗这种潜在的严重并发症，而癫痫发作相关性 DAH 在癫痫患者中是预后不良的。
