Consenso argentino de ventilación no invasiva / Argentine consensus of non-invasive ventilation

Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.(AU)

La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro delas complicaciones causadas por la intubación traqueal la hace especialmente atractiva en pacientesque presentan insuficiencia respiratoria aguda (IRA) no muy grave y que conservan cierta autonomía respiratoria.También se han descripto efectos terapéuticos en pacientes con insuficiencia respiratoria crónica de etiologías diversas. No obstante, los resultados obtenidos son variables según las circunstancias que motivan su aplicación. A fin de revisar la evidencia a favor de su uso se elaboró este Consenso referido particularmente a la VNI a presión positiva. Se describen su fundamento fisiopatológico, esencial para su correcta aplicación, y elequipamiento necesario para implementarla. La evidencia existente en la literatura establece definida utilidad de la VNI en la exacerbación de la EPOC y en el edema agudo de pulmón cardiogénico (Recomendación A).Su beneficio es aún incierto en pacientes con IRA secundaria a síndrome de dificultad respiratoria aguda, salvoen el subgrupo de pacientes inmunosuprimidos (Recomendación B). Los resultados son también favorablesen la desvinculación de la asistencia respiratoria mecánica (ARM), especialmente en pacientes ventilados por exacerbación de EPOC (Recomendación A). En la insuficiencia respiratoria crónica se ha hallado mejoría en la calidad de vida y mayor sobrevida en pacientes con enfermedades restrictivas (Recomendación B), mientrasque existe aún controversia sobre su utilidad en pacientes con EPOC estable (Recomendación C). La VNI debeser aplicada con estándares de cuidados que son establecidos. Se revisan las eventuales complicaciones derivadasde su uso y el beneficio costo-efectividad ahorrando recursos de mayor complejidad y disminuyendolos riesgos que implica la ARM invasiva.(AU)

Consenso argentino de ventilación no invasiva / Argentine consensus of non-invasive ventilation

Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.

La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro delas complicaciones causadas por la intubación traqueal la hace especialmente atractiva en pacientesque presentan insuficiencia respiratoria aguda (IRA) no muy grave y que conservan cierta autonomía respiratoria.También se han descripto efectos terapéuticos en pacientes con insuficiencia respiratoria crónica de etiologías diversas. No obstante, los resultados obtenidos son variables según las circunstancias que motivan su aplicación. A fin de revisar la evidencia a favor de su uso se elaboró este Consenso referido particularmente a la VNI a presión positiva. Se describen su fundamento fisiopatológico, esencial para su correcta aplicación, y elequipamiento necesario para implementarla. La evidencia existente en la literatura establece definida utilidad de la VNI en la exacerbación de la EPOC y en el edema agudo de pulmón cardiogénico (Recomendación A).Su beneficio es aún incierto en pacientes con IRA secundaria a síndrome de dificultad respiratoria aguda, salvoen el subgrupo de pacientes inmunosuprimidos (Recomendación B). Los resultados son también favorablesen la desvinculación de la asistencia respiratoria mecánica (ARM), especialmente en pacientes ventilados por exacerbación de EPOC (Recomendación A). En la insuficiencia respiratoria crónica se ha hallado mejoría en la calidad de vida y mayor sobrevida en pacientes con enfermedades restrictivas (Recomendación B), mientrasque existe aún controversia sobre su utilidad en pacientes con EPOC estable (Recomendación C). La VNI debeser aplicada con estándares de cuidados que son establecidos. Se revisan las eventuales complicaciones derivadasde su uso y el beneficio costo-efectividad ahorrando recursos de mayor complejidad y disminuyendolos riesgos que implica la ARM invasiva.

Encuesta a neumonologos sobre el diagnostico y tratamiento de EPOC / Survey of chest physicians regarding COPD diagnosis and treatment

A survey on COPD diagnostic procedures, treatment and management was conducted in a group of 517 chest physicians randomized from a list of the 1121 affiliates to the Asociación Argentina de Medicina Respiratoria. One hundred eighty-seven responses were obtained (36.2% of the questionnaires mailed). They treat an average of 53.3 COPD patients every month. Twenty-four percent of them had mild, 41.8% moderate and 33.8% severe disease (GOLD criteria). Only clinical criteria for diagnosis of COPD, clinical criteria + spirometry (S), and clinical criteria + S + chest X ray were used by 2.9, 23.4 and 73.7% of responders, respectively. Seventy percent of responders believed that chronic asthma without bronchodilator response must be included in the COPD definition. Only 14.1% of responders performed S in every office visit. Cardiac function was assessed using clinical criteria, electrocardiogram and echocardiogram by 90.6, 80.6 and 73.8% of responders, respectively, while 98.3% stated that they trained most of their patients in the inhalation technique. Metered Dose Inhaled was the first option for bronchodilators administration (64.8%) followed by nebulization (16.5%), dry powder inhalation (13.7%) and oral administration (4.8%). First option for chronic therapy in severe COPD patients was the association of anticholinergic drug (AC) + short acting beta2-agonists (SABA) (65.5%), AC alone (18.8%), long acting beta2-agonists (LABA) (9.7%), inhaled corticosteroids (IC) (3.5%) and SABA alone (2.8%). Corticosteroids and antibiotics were prescribed in severe COPD exacerbation by 92.5 and 70% of responders, respectively. First choice antibiotic formulation was beta-lactamics + beta-lactamase inhibitors in 39% of the responders followed by fluorquinolones in 23.7%, macrolides in 17.5% and beta-lactamics in 12.5%. Lastly, 12.7% of COPD patients received long-term domiciliary oxygen therapy. 59.3% of them were prescribed pulmonary rehabilitation, 94.1% vaccination against in...(AU)

Se realizo una encuesta acerca de diagnostico y tratamiento de EPOC a un grupo de 517 especialistasen neumonologia, seleccionados al azar entre los 1121 integrantes de la Asociacion Argentina de Medicina Respiratoria. Se obtuvieron 187 respuestas (36.2%). Atienden en promedio 53.3 pacientes con EPOC/mes, a los cuales definen como leves el 24.2%, moderados el 41.8% y severos el 33.8% (criterios normativos GOLD).El criterio utilizado para el diagnostico de EPOC fue solo clinico en el 2.9%, clinico y espirometria (ESP) en el 23.4%y clinico, ESP y por imagenes en el 73.7%. El 70.1% de los encuestados incluye dentro de la definicion de EPOC al asma cronico de escasa respuesta a broncodilatadores. Solo el 14.1% manifiesta realizar espirometria en cada consulta. La evaluacion de la funcion cardiaca la realizan en EPOC severa por examen clinico (90.6%), electrocardiograma (80.6%) y ecocardiograma (73.8%). El 98.3% de los encuestados afirma que la mayoria de los pacientes son instruidosen la realizacion de maniobras de inhalacion de medicamentos. Eligieron como primera opcion para administrarbroncodilatadores en aerosol (64.8%), nebulizacion (16.5%), polvo (13.7%) y via oral (4.8%). El 65.5% eligio comoprimera opcion de tratamiento cronico a los anticolinergicos (AC) + beta2-agonistas de acción corta (BAAC), 18.8% ACsolos, 9.7% beta2-agonistas de accion larga (BAAL), 3.5% corticoides inhalados (CI) y 2.8% BAAC solos. Los corticoides sistemicos y los antibioticos fueron utilizados en las reagudizaciones severas por el 92.5% y el 70% de los encuestados, respectivamente. En esa situacion, como antibioticos de primera eleccion, fueron elegidos los beta lactamicos + inhibidores de beta-lactamasa por el 39.1% de los encuestados, fluorquinolonas (23.7%), macrolidos (17.4%) y betalactamicos...(AU)

Encuesta a neumonologos sobre el diagnostico y tratamiento de EPOC / Survey of chest physicians regarding COPD diagnosis and treatment

A survey on COPD diagnostic procedures, treatment and management was conducted in a group of 517 chest physicians randomized from a list of the 1121 affiliates to the Asociación Argentina de Medicina Respiratoria. One hundred eighty-seven responses were obtained (36.2% of the questionnaires mailed). They treat an average of 53.3 COPD patients every month. Twenty-four percent of them had mild, 41.8% moderate and 33.8% severe disease (GOLD criteria). Only clinical criteria for diagnosis of COPD, clinical criteria + spirometry (S), and clinical criteria + S + chest X ray were used by 2.9, 23.4 and 73.7% of responders, respectively. Seventy percent of responders believed that chronic asthma without bronchodilator response must be included in the COPD definition. Only 14.1% of responders performed S in every office visit. Cardiac function was assessed using clinical criteria, electrocardiogram and echocardiogram by 90.6, 80.6 and 73.8% of responders, respectively, while 98.3% stated that they trained most of their patients in the inhalation technique. Metered Dose Inhaled was the first option for bronchodilators administration (64.8%) followed by nebulization (16.5%), dry powder inhalation (13.7%) and oral administration (4.8%). First option for chronic therapy in severe COPD patients was the association of anticholinergic drug (AC) + short acting beta2-agonists (SABA) (65.5%), AC alone (18.8%), long acting beta2-agonists (LABA) (9.7%), inhaled corticosteroids (IC) (3.5%) and SABA alone (2.8%). Corticosteroids and antibiotics were prescribed in severe COPD exacerbation by 92.5 and 70% of responders, respectively. First choice antibiotic formulation was beta-lactamics + beta-lactamase inhibitors in 39% of the responders followed by fluorquinolones in 23.7%, macrolides in 17.5% and beta-lactamics in 12.5%. Lastly, 12.7% of COPD patients received long-term domiciliary oxygen therapy. 59.3% of them were prescribed pulmonary rehabilitation, 94.1% vaccination against in...

Se realizo una encuesta acerca de diagnostico y tratamiento de EPOC a un grupo de 517 especialistasen neumonologia, seleccionados al azar entre los 1121 integrantes de la Asociacion Argentina de Medicina Respiratoria. Se obtuvieron 187 respuestas (36.2%). Atienden en promedio 53.3 pacientes con EPOC/mes, a los cuales definen como leves el 24.2%, moderados el 41.8% y severos el 33.8% (criterios normativos GOLD).El criterio utilizado para el diagnostico de EPOC fue solo clinico en el 2.9%, clinico y espirometria (ESP) en el 23.4%y clinico, ESP y por imagenes en el 73.7%. El 70.1% de los encuestados incluye dentro de la definicion de EPOC al asma cronico de escasa respuesta a broncodilatadores. Solo el 14.1% manifiesta realizar espirometria en cada consulta. La evaluacion de la funcion cardiaca la realizan en EPOC severa por examen clinico (90.6%), electrocardiograma (80.6%) y ecocardiograma (73.8%). El 98.3% de los encuestados afirma que la mayoria de los pacientes son instruidosen la realizacion de maniobras de inhalacion de medicamentos. Eligieron como primera opcion para administrarbroncodilatadores en aerosol (64.8%), nebulizacion (16.5%), polvo (13.7%) y via oral (4.8%). El 65.5% eligio comoprimera opcion de tratamiento cronico a los anticolinergicos (AC) + beta2-agonistas de acción corta (BAAC), 18.8% ACsolos, 9.7% beta2-agonistas de accion larga (BAAL), 3.5% corticoides inhalados (CI) y 2.8% BAAC solos. Los corticoides sistemicos y los antibioticos fueron utilizados en las reagudizaciones severas por el 92.5% y el 70% de los encuestados, respectivamente. En esa situacion, como antibioticos de primera eleccion, fueron elegidos los beta lactamicos + inhibidores de beta-lactamasa por el 39.1% de los encuestados, fluorquinolonas (23.7%), macrolidos (17.4%) y betalactamicos...

[Survey among chest physicians regarding the diagnosis and management of asthma]. / Encuesta a médicos especialistas sobre el diagnóstico y el manejo del asma bronquial.

A survey on asthma management was conducted in 300 chest physicians randomized from a national list. Diagnosis procedures, methods for recognizing life-threatening asthma attacks and patient education about his or her disease were reviewed. Ninety-eight responses were obtained (32.7% of the questionnaires mailed). 71% of the responders were specialized in respiratory medicine (RM), 12% in RM + Internal Medicine (IM), 6% in RM + Allergy (A), 5% in A, 4% in IM, and 2% in IM + A. As a diagnostic test, immediate response to bronchodilator was seldom used and a trial course of oral steroids was even less used. Blood eosinophilia and specific IgE RAST were frequently used and more than in other compared countries in spite of its doubtfulness for the diagnosis of asthma. Severity of asthma attack was assessed less than in other countries in relation to symptoms, lack of response to inhaled bronchodilators and with practically no use of any objective method for the assessment of airways obstruction (PEFR). The latter was seldom employed for chronic control of the disease. The assessment of the correct technique of metered dose inhaler or dry powder inhaler use was rarely done. Only the questions referred to patient education about their disease, teaching about the difference between relieving (bronchodilator) and anti-inflammatory treatment, communication to the patient about the severity of his or her disease and the frequency of giving a written action plan in case of severe asthma attacks qualified equal or better than countries that always qualified well. These responses, together with other data of the literature, makes us suspect, as is common in these audits, that the interviewed person sometimes replies what he or she should do, but not necessarily what he or she does.

Encuesta a médicos especialistas sobre el diagnóstico y el manejo del asma bronquial. / [Survey among chest physicians regarding the diagnosis and management of asthma]

A survey on asthma management was conducted in 300 chest physicians randomized from a national list. Diagnosis procedures, methods for recognizing life-threatening asthma attacks and patient education about his or her disease were reviewed. Ninety-eight responses were obtained (32.7

of the questionnaires mailed). 71

of the responders were specialized in respiratory medicine (RM), 12

in RM + Internal Medicine (IM), 6

in RM + Allergy (A), 5

in A, 4

in IM, and 2

in IM + A. As a diagnostic test, immediate response to bronchodilator was seldom used and a trial course of oral steroids was even less used. Blood eosinophilia and specific IgE RAST were frequently used and more than in other compared countries in spite of its doubtfulness for the diagnosis of asthma. Severity of asthma attack was assessed less than in other countries in relation to symptoms, lack of response to inhaled bronchodilators and with practically no use of any objective method for the assessment of airways obstruction (PEFR). The latter was seldom employed for chronic control of the disease. The assessment of the correct technique of metered dose inhaler or dry powder inhaler use was rarely done. Only the questions referred to patient education about their disease, teaching about the difference between relieving (bronchodilator) and anti-inflammatory treatment, communication to the patient about the severity of his or her disease and the frequency of giving a written action plan in case of severe asthma attacks qualified equal or better than countries that always qualified well. These responses, together with other data of the literature, makes us suspect, as is common in these audits, that the interviewed person sometimes replies what he or she should do, but not necessarily what he or she does.

[Survey of medical specialists regarding bronchial asthma treatment]. / Encuesta a médicos especialistas sobre el tratamiento del asma bronquial.

A survey about asthma management was conducted in a group of 300 chest physicians randomized from a list of the whole country. This paper dealt with the questions about treatment in acute asthma and during maintenance therapy in adults and in children older than 6 years. Of the questionnaires mailed, 98 responses were obtained (32.7%)); 71% of the responders were respiratory medicine specialists (RM), 12% RM + Internal Medicine (IM), 6% in RM + Allergy (A), 5% in A, 4% in IM and 2% in IM + A. For the treatment of acute severe episodes 57.5% of the physicians chose nebulized or inhaled beta agonists (IBA) as the first choice for adults and 63.4% for children, parenteral steroids 26.3% in adults and 22.5% in children. For maintenance therapy, the first choice formulation was IBA for adults in 37.6% of the responders and inhaled steroid (IS) in 34.1% of them. In children, 34.7% of the responders choose IBA, 25.3% cromoglicate or nedocromil and 14.7% IS. IBA were prescribed more commonly for treating symptoms, secondly for preventing symptoms and in third place for continuous preventive treatment in adults and in children. The recommendation of IBA for treating and preventing symptoms were more commonly done in children. The average normal daily dose of IS was 297 and 254 micrograms for adults and children, respectively. The average maximal dose was 1176 and 618 micrograms for adults and children, respectively. The recommendation of hyposensitization for allergic asthma was, as mean score of frequency of use (from 0 = never to 3 = always), 0.96 for adults and 1.13 for children. Important drawbacks were detected in the treatment approach. In acute asthma episodes about 40% of the responders did not use IBA as the first choice of treatment. For maintenance treatment IS were rarely used, and their doses were less than the usually recommended by different guidelines. IBA were seldom recommended for prevention or treatment of symptoms. They are used moderately as continuous preventive treatment. Hyposensitization is commonly recommended and more frequently used than in other countries.

[Effect of diazoxide on severe pulmonary hypertension]. / Efecto del diazoxido en la hipertensión pulmonar severa.

Hemodynamic effects were studied after the administration of incremental doses of diazoxide (upper range 300-600 mg) in a group of 15 patients with severe pulmonary hypertension due to different etiologies. No significant changes were found in the mean pulmonary arterial pressure (PAP), "wedge" pressure, right atrial pressure, and right ventricular systolic work index (RVSWI). Significant decreases were found in the mean systemic arterial pressure, pulmonary arterial resistance (PAR), systemic arterial resistance (SAR) and left ventricular systolic work index (LVSWI). Significant increments were found in the cardiac output (Q), heart rate and PAR/SAR ratios (Table 1). A significant correlation was found between Q and SAR pretreatment (r = -0.75, p less than 0.002); PAR and SAR pretreatment (r = 0.69, p less than (0.01); change in SAR vs change in Q produced by diazoxide (r = -0.81, p 0.001); basal PAR/SAR vs D PAP (change pre-post diazoxide) (r = -0.58, p less than 0.05); % PAR/SAR vs % PAP (percent changes in PAR/SAR post diazoxide vs percent change of PAP post diazoxide) (r = 0.78, p less than 0.001); D PAP vs D RVSWI (PAP change post diazoxide vs RVSWI change post diazoxide) r = 0.79, p less than 0.001. No significant correlation (either in absolute or in percent values) was found between basal values of pulmonary artery pressure, cardiac output, pulmonary arterial resistance or right ventricular systolic work index vs those produced by the drug in the same parameters. Patients were divided into two groups according to the decrease or increase of pulmonary arterial pressure after diazoxide administration (n = 7 and 8, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Efecto del diazoxido en la hipertensión pulmonar severa. / [Effect of diazoxide on severe pulmonary hypertension]

Hemodynamic effects were studied after the administration of incremental doses of diazoxide (upper range 300-600 mg) in a group of 15 patients with severe pulmonary hypertension due to different etiologies. No significant changes were found in the mean pulmonary arterial pressure (PAP), [quot ]wedge[quot ] pressure, right atrial pressure, and right ventricular systolic work index (RVSWI). Significant decreases were found in the mean systemic arterial pressure, pulmonary arterial resistance (PAR), systemic arterial resistance (SAR) and left ventricular systolic work index (LVSWI). Significant increments were found in the cardiac output (Q), heart rate and PAR/SAR ratios (Table 1). A significant correlation was found between Q and SAR pretreatment (r = -0.75, p less than 0.002); PAR and SAR pretreatment (r = 0.69, p less than (0.01); change in SAR vs change in Q produced by diazoxide (r = -0.81, p 0.001); basal PAR/SAR vs D PAP (change pre-post diazoxide) (r = -0.58, p less than 0.05);

PAR/SAR vs

PAP (percent changes in PAR/SAR post diazoxide vs percent change of PAP post diazoxide) (r = 0.78, p less than 0.001); D PAP vs D RVSWI (PAP change post diazoxide vs RVSWI change post diazoxide) r = 0.79, p less than 0.001. No significant correlation (either in absolute or in percent values) was found between basal values of pulmonary artery pressure, cardiac output, pulmonary arterial resistance or right ventricular systolic work index vs those produced by the drug in the same parameters. Patients were divided into two groups according to the decrease or increase of pulmonary arterial pressure after diazoxide administration (n = 7 and 8, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Efecto del diazoxido en la hipertension pulmonar severa / Effect of diazoxide on severe pulmonary hypertension

Se estudiaron los efectos hemodinámicos de la administración de dosis crecientes de diazóxido (hasta 300 o 600 mg) en 15 pacientes con hipertensión pulmonar de distinta etiología. En promedio nos e encontraron cambios significativos de las presiones en arteria pulmonar (PAP), wedge, auricular derecha e índice de trabajo sistólico ventricular derecho (ITSVD). Se observaron disminuciones significativas de la presión arterial sistémica, de la resistencia pulmonar (RAP), resistencia arterial sistémica (RAS) y el índice de trabajo sistólico ventricular izquierdo (TSVI). Aumentaron significativamente el volumen minuto circulatório (Q), la frecuencia cardíaca y la relación RAP/RAS. Se encontraron correlaciones significativas entre el Q y RAS pretratamiento; RAP y RAS pretratamiento; disminución de RAS vs aumento de Q; RAP/RAS basal vs D PAP (cambio pre-post diazóxido); entre % RAP/RAS vs % PAP (porciento de cambio RAP/RAS post diazóxido de cambio de presión en arteria pulmonar post diazóxido); D PAP vs S ITSVD (cambios post diazóxido vs cambio de ITSVD post droga). No se encontraron correlaciones significativas entre valores basales de presión en arteria pulmonar, volumen minuto, resistencia arterial pulmonar o índice de trabajo ventricular derecho vs los cambios ocasionados por el diazóxido (ya sea en valores absolutos e ne porcentage) de presión en arteria pulmonar, volumen minuto o resistencia arterial pulmonar. En los pacientes en los que disminuyó la presión en la arteria pulmonar se observó, respecto de los que no disminuyó, valores basales mayores de presión en arteria pulmonar, resistencia arterial pulmonar y relación RAP/RAS. Asimismo el porcentaje de cambio de RAP/RAS (%RAP/RAS) fue menor en el primer grupo. Desde el punto de vista predicitvo la presión en la arteria pulmonar disminuyó en el grupo de pacientes con valores más altos de PAP, RAP y RAP/RAS. Esto sugeriría que el diazóxido tiene más posibilidad de disminuir la presión en arteria pulmonr en pacientes más comprometidos (UA)

Efecto del diazoxido en la hipertension pulmonar severa / Effect of diazoxide on severe pulmonary hypertension

Se estudiaron los efectos hemodinámicos de la administración de dosis crecientes de diazóxido (hasta 300 o 600 mg) en 15 pacientes con hipertensión pulmonar de distinta etiología. En promedio nos e encontraron cambios significativos de las presiones en arteria pulmonar (PAP), wedge, auricular derecha e índice de trabajo sistólico ventricular derecho (ITSVD). Se observaron disminuciones significativas de la presión arterial sistémica, de la resistencia pulmonar (RAP), resistencia arterial sistémica (RAS) y el índice de trabajo sistólico ventricular izquierdo (TSVI). Aumentaron significativamente el volumen minuto circulatório (Q), la frecuencia cardíaca y la relación RAP/RAS. Se encontraron correlaciones significativas entre el Q y RAS pretratamiento; RAP y RAS pretratamiento; disminución de RAS vs aumento de Q; RAP/RAS basal vs D PAP (cambio pre-post diazóxido); entre % RAP/RAS vs % PAP (porciento de cambio RAP/RAS post diazóxido de cambio de presión en arteria pulmonar post diazóxido); D PAP vs S ITSVD (cambios post diazóxido vs cambio de ITSVD post droga). No se encontraron correlaciones significativas entre valores basales de presión en arteria pulmonar, volumen minuto, resistencia arterial pulmonar o índice de trabajo ventricular derecho vs los cambios ocasionados por el diazóxido (ya sea en valores absolutos e ne porcentage) de presión en arteria pulmonar, volumen minuto o resistencia arterial pulmonar. En los pacientes en los que disminuyó la presión en la arteria pulmonar se observó, respecto de los que no disminuyó, valores basales mayores de presión en arteria pulmonar, resistencia arterial pulmonar y relación RAP/RAS. Asimismo el porcentaje de cambio de RAP/RAS (%RAP/RAS) fue menor en el primer grupo. Desde el punto de vista predicitvo la presión en la arteria pulmonar disminuyó en el grupo de pacientes con valores más altos de PAP, RAP y RAP/RAS. Esto sugeriría que el diazóxido tiene más posibilidad de disminuir la presión en arteria pulmonr en pacientes más comprometidos