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Stratégie diagnostique devant une insuffisance respiratoire aiguë chez un patient d’oncohématologie admis en réanimation

  • D. Schnell
  • É. AzoulayEmail author
Chapter
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Part of the Références en réanimation. Collection de la SRLF book series (SRLF)

Résumé

L’insuffisance respiratoire aiguë (IRA) est définie par des critères cliniques comme la polypnée, le recrutement des muscles respiratoires accessoires ou l’épuisement respiratoire, une saturation en oxygène à moins de 90 % en air ambiant ou la nécessité d’oxygène au masque à haute concentration, et la nécessité de recours à un support ventilatoire invasif ou non. Elle reste un événement préoccupant chez les patients traités pour un cancer ou une hémopathie maligne. En effet, l’IRA chez les patients d’oncohématologie (POH) est fréquente, grave, et encore souvent mortelle. Elle pose des problèmes diagnostiques et thérapeutiques, et sa prise en charge reste à ce jour controversée bien que codifiée [1–3]. L’IRA est fréquente chez les POH, compliquant près de 5 % des tumeurs solides et jusque 20 % des hémopathies malignes [4]. Chez les patients neutropéniques ou greffés de moelle, elle survient jusque dans 30 % des cas [2, 5–8]. Cette incidence est croissante du fait de la constante augmentation des pathologies malignes [9, 10] et de l’allongement de l’espérance de vie des POH [11] grâce à l’amélioration des traitements supportifs [12–15] et à l’administration de traitements curatifs de plus en plus intensifs [16–18] mais immanquablement de plus en plus immunosuppresseurs ou toxiques [18–20].

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Copyright information

© Springer-Verlag Paris 2013

Authors and Affiliations

  1. 1.Service de réanimation médicaleHôpital Saint-Louis et Université Paris 7ParisFrance

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