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Giãn phế quản Tình trạng này được đặc trưng bởi sự giãn nở ít nhất là một số trong các phế quản mãn tính. Các bức tường phế quản bị hư hỏng không thể phục hồi như một hệ quả của viêm sớm hoặc nhiễm trùng hoặc phổi phế quản hoặc vận chuyển liền kề parenchyma. | ACUTE MEDICAL emergencies the practical approach Bronchiectasis This condition is characterised by chronic dilatation of at least some of the bronchi.The bronchial wall is irreversibly damaged as a consequence of early inflammation or infection of either the bronchus or adjacent lung parenchyma.The normal transport of mucus is impaired and chronic local suppuration ensues. A variety of conditions are associated with bronchiectasis and they are shown in the box. Conditions associated with bronchiectasis Infection Measles pneumonia Whooping cough Tuberculosis Immune related Immunoglobulin deficiency Complement deficiency Inhalation Gastric aspiration Ammonia inhalation Foreign body inhalation Others Immotile cilia Kartagener s syndrome a1 antitrypsin deficiency The pathophysiology of bronchiectasis is poorly understood. Despite the wide variety of conditions associated with bronchiectasis there are certain common features. Firstly a severe infection causes extensive tissue damage mediated by persistent inflammation. The repair processes however are inadequate for example with immunoglobulin deficiency or lack of major inhibitors of proteolytic enzymes i.e. a-1-antitrypsin deficiency. If the inflammation is left unchecked extensive tissue destruction inadequate repair scarring and tissue distortion occur. As focal areas of the lungs framework are destroyed the associated bronchoalveolar units become dilated. Assessment Usually the patient with respiratory failure will be unable to complete sentences. Accessory muscle use is prominent and the patients are often either hyperventilating or cyanosed with plethoric facies and laboured respiration. A tachycardia is invariably present. Immediate management In all of these patients it is important to 1. treat hypoxaemia 2. identify and treat the reason for the acute exacerbation 3. assess the severity of the respiratory failure 4. monitor the response to treatment. Hypoxaemia kills. Therefore patients should receive high flow
