tailieunhanh - Báo cáo y học: "Clinical review: Vasculitis on the intensive care unit – part 2: treatment and prognosis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Clinical review: Vasculitis on the intensive care unit – part 2: treatment and prognosis. | Available online http content 9 2 193 Review Clinical review Vasculitis on the intensive care unit - part 2 treatment and prognosis David Semple1 James Keogh2 Luigi Forni3 and Richard Venn4 Specialist Registrar Renal Medicine Worthing Hospital Worthing UK Specialist Registrar Anaesthetics Worthing Hospital Worthing UK 3Consultant Physician Worthing Hospital Worthing UK 4Consultant Anaesthetist Worthing Hospital Worthing UK Corresponding author David Semple Published online 18 August 2004 This article is online at http content 9 2 193 2004 BioMed Central Ltd Critical Care 2005 9 193-197 DOI cc2937 See review issue page 92 http content 9 1 92 Abstract The second part of this review addresses the treatment and prognosis of the vasculitides Wegener s granulomatosis microscopic polyangiitis Churg-Strauss syndrome and polyarteritis nodosa. Treatment regimens consist of an initial remission phase with aggressive immunosuppression followed by a more prolonged maintenance phase using less toxic agents and doses. This review focuses on the initial treatment of fulminant vasculitis the mainstay of which remains immunosuppression with steroids and cyclophosphamide. For Wegener s granulomatosis and microscopic polyangiitis plasma exchange can be considered for first-line therapy in patients with acute renal failure and or pulmonary haemorrhage. Refractory disease is rare and is usually due to inadequate treatment. The vasculitides provide a particular challenge for the critical care team. Particular aspects of major organ support related to these conditions are discussed. Effective treatment has revolutionized the prognosis of these conditions. However mortality is still approximately 50 for those requiring admission to intensive care unit. Furthermore there is a high morbidity associated with both the diseases themselves and the treatment. Introduction Systemic necrotizing vasculitis represents a major .

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