Exploración funcional pulmonar en pacientes con hipertensión arterial pulmonar / Lung function testing in patients with pulmonary arterial hypertension

Objetivo: El objetivo principal es la descripción de los hallazgos funcionales respiratorios en una serie de 120 pacientes con hipertensión arterial pulmonar (HAP), y el objetivo secundario es su comparación con los datos hemodinámicos. Pacientes y métodos: Estudio descriptivo de la función pulmonar de los 120 casos con HAP estable, de los grupos 1 y 4 de Evian/Venecia, estudiados hasta enero de 2002 en el grupo de trabajo de Hipertensión Pulmonar y Trasplante de Pulmón del Servicio de Cardiología del Hospital Universitario 12 de Octubre de Madrid. Los datos de 47 pacientes se recogieron retrospectivamente desde 1981 a 1995, y de forma prospectiva en los 73 restantes. Se incluyeron casos de hipertensión arterial idiopática y de la asociada a colagenosis, tromboembolia pulmonar crónica, shunt cardíaco y, en 30 casos, a síndrome de aceite tóxico (SAT). Resultados: En el conjunto del grupo la capacidad vital, el volumen espiratorio forzado en el primer segundo y la capacidad pulmonar total fueron normales; los valores medios mostraron un factor de transferencia bajo (media ± desviación estándar: 67,6 ± 23,2), e hipoxemia moderada (65,8 ± 15,4 mmHg). No se observaron asociaciones significativas entre los parámetros funcionales pulmonares y los hemodinámicos. El grupo con SAT tenía la edad más baja (33,7 ± 11,4 años), junto a los valores medios más altos en la escala de la New York Heart Association (3,3 ± 0,5) y de resistencias vasculares pulmonares (20,3 ± 8,1 kPa·l­-1·s). Conclusiones: En este trabajo se estudia la función pulmonar en una serie de 120 pacientes con HAP, de los grupos 1 y 4 de Evian/Venecia, entre los que se incluyó a 30 casos con SAT. No se han encontrado asociaciones significativas entre los valores funcionales respiratorios y los hemodinámicos

Objective: The main objective was to describe the results of lung function testing in a series of 120 patients with pulmonary arterial hypertension, and the secondary objective was to compare these findings with hemodynamic variables. Patients and Methods: This was a descriptive study of lung function in 120 patients with stable pulmonary arterial hypertension (Evian/Venice groups 1 and 4) studied until January 2002 in the Pulmonary Hypertension and Lung Transplant Working Group attached to the Cardiology Department of the Hospital Universtario 12 de Octubre in Madrid, Spain. Data were collected retrospectively for the first 47 patients (1981 to 1995) and prospectively thereafter for the remaining 73 patients. The diagnosis was idiopathic arterial hypertension or hypertension associated with collagenosis, chronic pulmonary embolism, cardiac shunt, or toxic oil syndrome (30 cases). Results: In the group as a whole, forced vital capacity, forced expiratory volume in 1 second, and total lung capacity were normal; mean (SD) values revealed low carbon dioxide diffusing capacity (67.6% [23.2%]), and moderate hypoxemia (65.8 [15.4] mm Hg). No significant associations were observed between lung function and hemodynamic parameters. Mean age in the toxic oil syndrome group was lower (33.7 [11.4] years), and these patients had higher mean scores on the New York Heart Association scale (3.3 [0.5]) and for pulmonary vascular resistance (20.3 [8.1] kPa·L-­1·s). Conclusions: Lung function was studied in a series of 120 patients with pulmonary arterial hypertension (Evian/ Venice groups 1 and 4), 30 of whom had toxic oil syndrome. No significant associations were found between lung function and hemodynamic parameters

Transdiaphragmatic pressure in quadriplegic individuals ventilated by diaphragmatic pacemaker.

BACKGROUND: Electrophrenic pacing can be used in the management of ventilatory failure in quadriplegic patients. A study was undertaken to determine the pattern of transdiaphragmatic pressure (PDI) during the conditioning phase of electrophrenic pacing to see if it had a possible role in optimising the process of conditioning. METHODS: The tidal volume (TV) and PDI were measured in a group of six quadriplegic patients commencing ventilation by low frequency pulse stimulation (7-10 Hz) and low respiratory rate stimulation (< 10 breaths/min). RESULTS: Tidal volume increased between baseline and month 1 (4.33 ml/kg, p < 0.001) and between months 1 and 2 (3.00 ml/kg, p < 0.05) and then stabilised. PDI was higher during bilateral diaphragmatic pacing (mean (SD) 1.73 (0.30) kPa) than with either left (1.15 (0.34) kPa) or right (0.86 (0.37) kPa) unilateral pacing. PDI varied throughout the observation period, probably by interaction between recovery of the diaphragmatic fibres and the pacing regimen. CONCLUSIONS: Patients with quadriplegia due to high spinal injury can be maintained with ventilation by continuous electrophrenic pacing. The control criteria used in this study for pacing were tidal volume and the patient's tolerance, and the PDI measurement did not contribute any additional information to help with managing the conditioning process.

A case of dirhythmic breathing.

We describe a case of dirhythmic breathing in a 60-year-old man after neurosurgery. A large hemangioblastoma was removed from the cerebellum at the level of the fourth ventricle. The spirometric tracings showed two types of respiratory cycles: the rhythm. A was stable with a short inspiratory time; sometimes a second type of respiratory cycle, B, was present or erratically coupled with the A rhythm. It had very small tidal volume and mean inspiratory flow with phasic variations similar to those observed in Cheyne-Stokes breathing pattern.