Medicina intensiva
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Comparative Study
Comparison of bronchoscopic bronchoalveolar lavage vs blind lavage with a modified nasogastric tube in the etiologic diagnosis of ventilator-associated pneumonia.
Our objective was to compare the results of a blind lavage vs a bronchoscopic-guided bronchoalveolar lavage for the etiologic diagnosis of ventilator-associated pneumonia (VAP). ⋯ The blind bronchoalveolar lavage with a modified nasogastric tube is a valuable tool for the identification of etiologic agent in VAP, particularly when trained bronchoscopists or the necessary resources for bronchoscopic-guided bronchoalveolar lavage are not readily available.
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Cerebrovascular accident in young adults is not rare and the most common causes are: cardiac embolism, arterial dissection and migraine. The unknown etiology, in spite of extensive studies, is described in the literature in about one third of patients under 45 years of age. The mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) may occur with symptoms that simulate a stroke. ⋯ We describe the case of an 18-year old patient who was admitted to the Intensive Care Unit due to a sudden picture of blindness. The ophthalmologic study was normal and the neuroimaging studies showed infarction in both occipital lobules. We explain the different clinical features, diagnostic, therapeutic and prognostic methods of the disease.