Hemoglobina Denver, una causa de desaturación en oximetría de pulso. Reporte de caso en un paciente pediátrico / Hemoglobin Denver, a cause of desaturated pulse oximetry. A pediatric case report

Las hemoglobinopatías son trastornos genéticos que afectan a la molécula de hemoglobina (Hb). Las mutaciones en las cadenas a o b que alteran el tetrámero de Hb pueden modificar la capacidad de la molécula para unirse al oxígeno. Las hemoglobinopatías con baja afinidad al oxígeno pueden presentarse con cianosis y una lectura alterada de la oximetría de pulso, lo que lleva a pruebas innecesarias y, a veces, invasivas para descartar afecciones cardiovasculares y respiratorias. En el siguiente reporte de caso, presentamos a una paciente pediátrica, asintomática, que se presentó a la consulta por detección de desaturación en oximetría de pulso. Las pruebas de laboratorio iniciales mostraron una anemia normocítica, normocrómica. Las muestras de gas venoso demostraron una p50 elevada. Después de extensas herramientas de diagnóstico, se diagnosticó una variante de Hb con baja afinidad al oxígeno, Hb Denver.

Hemoglobinopathies are genetic disorders that affect the hemoglobin (Hb) molecule. Mutations in the alpha or beta chains altering the Hb tetramer may modify the molecule's oxygen-binding capacity. Hemoglobinopathies with low oxygen affinity may occur with cyanosis and an altered pulse oximetry reading, leading to unnecessary and sometimes invasive tests to rule out cardiovascular and respiratory conditions. In the case report described here, we present an asymptomatic pediatric patient who consulted for desaturated pulse oximetry. Her initial laboratory tests showed normocytic, normochromic anemia. Venous blood gas samples showed an elevated p50. After using extensive diagnostic tools, a variant of Hb with low oxygen affinity was diagnosed: Hb Denver.

Presión intraabdominal y ventilación artificial mecánica. Hospital "Arnaldo Milián Castro". 2014-2015 / Intra-abdominal pressure and mechanical artificial ventilation. Arnaldo Milián Castro Hospital. 2014-2015

Introducción: La cavidad abdominal y la caja torácica se encuentran separadas por el diafragma, por lo que las variaciones en las presiones dentro de una, repercuten sobre las presiones de la otra. La hipertensión intraabdominal es hoy una entidad frecuente en el paciente crítico en el que constituye un factor de riesgo importante de complicaciones y mortalidad, ya que influye sobre órganos y sistemas. Objetivo: Relacionar la presión intraabdominal con presiones de la ventilación artificial mecánica y parámetros de la función respiratoria, cardiovascular y renal. Material y Métodos: Se realizó un estudio descriptivo y prospectivo de la presión intraabdominal en pacientes sometidos a ventilación mecánica, con enfermedades clínicas y quirúrgicas, en las Unidades de Cuidados Intensivos del Hospital Clínico Quirúrgico Arnaldo Milán Castro, durante el período comprendido entre enero 2014 hasta diciembre 2015. Resultados: Los pacientes clínicos con presiones de la vía aérea elevadas mostraron valores más altos de presión intraabdominal, y aquellos pacientes postquirúrgicos que cursaron con niveles altos de presión dentro del abdomen también presentaron los valores más elevados de presión pico y media registradas en el ventilador mecánico. Conclusiones: La tensión arterial media, el ritmo diurético y la saturación periférica de oxígeno disminuyeron, mientras que la presión venosa central, la presión parcial de dióxido de carbono en sangre y la creatinina aumentó ante los aumentos de la presión dentro del abdomen(AU)

Introduction: The abdominal cavity and the thoracic cage are separated by the diaphragm; therefore, the variations in the pressures within one of them have an effect on the pressures of the other. At present, intra-abdominal hypertension is a frequent entity in the critically ill patient, which constitutes an important risk factor for complications and mortality since it influences on different organs and systems. Objective: To relate intra-abdominal pressure with mechanical artificial ventilation pressures and parameters of respiratory, cardiovascular and renal function. Material and Methods: A descriptive prospective study of intra-abdominal pressure was conducted in patients undergoing mechanical ventilation with clinical and surgical diseases in the Intensive Care Units of the Arnaldo Milán Castro Hospital, during the period between January 2014 until December 2015. Results: Clinical patients with high values of airway pressures showed higher values of intra-abdominal pressure, and those post-surgical patients who presented with high levels of pressure inside the abdomen indicated the highest values of peak and average pressure recorded in the mechanical ventilator. Conclusions: Mean arterial pressure, diuretic rate and peripheral oxygen saturation decreased, whereas the central venous pressure, the partial pressure of carbon dioxide in blood, and creatinine increased due to raises in pressure within the abdomen(AU)

The Significance of Transcutaneous Continuous Overnight CO2 Monitoring in Determining Initial Mechanical Ventilator Application for Patients with Neuromuscular Disease

OBJECTIVE: To reveal the significance of continuous transcutaneous carbon dioxide (CO2) level monitoring through reviewing cases which showed a discrepancy in CO2 levels between arterial blood gas analysis (ABGA) and continuous transcutaneous blood gas monitoring. METHOD: Medical record review was conducted retrospectively of patients with neuromuscular diseases who had started home mechanical ventilation between June 2008 and May 2010. The 89 patients underwent ABGA at the 1st hospital day, and changes to their CO2 level were continuously monitored overnight with a transcutaneous blood gas analysis device. The number of patients who initially appeared to show normal PaCO2 through ABGA, yet displayed hypercapnea through overnight continuous monitoring, was counted. RESULTS: 36 patients (40.45%) presented inconsistent CO2 level results between ABGA and continuous overnight monitoring. The mean CO2 level of the 36 patients using ABGA was 37.23+/-5.11 mmHg. However, the maximum and mean CO2 levels from the continuous monitoring device were 52.25+/-6.87 mmHg and 46.16+/-6.08 mmHg, respectively. From the total monitoring period (357.28+/-150.12 minutes), CO2 retention over 45 mmHg was detected in 198.97 minutes (55.69%). CONCLUSION: Although ABGA only reflects ventilatory status at the puncturing moment, ABGA results are commonly used to monitor ventilatory status in most clinical settings. In order to decide the starting point of home mechanical ventilation in neuromuscular patients, continuous overnight monitoring should be considered to assess latent CO2 retention.