RESUMO
We report a case of a man in his 60s who developed pulmonary arterial hypertension (PAH) in association with profound vitamin C deficiency. Decreased availability of endothelial nitric oxide and activation of the hypoxia-inducible family of transcription factors, both consequences of vitamin C deficiency, are believed to be mechanisms contributing to the pathogenesis of the pulmonary hypertension. The PAH resolved following vitamin C supplementation. The current case highlights the importance of testing for vitamin C deficiency in patients with PAH in the proper clinical setting.
Assuntos
Deficiência de Ácido Ascórbico/complicações , Hipertensão Arterial Pulmonar/etiologia , Idoso , Anemia/etiologia , Artralgia/etiologia , Ácido Ascórbico/uso terapêutico , Deficiência de Ácido Ascórbico/tratamento farmacológico , Deficiência de Ácido Ascórbico/metabolismo , Cateterismo Cardíaco , Ecocardiografia , Endotélio Vascular/metabolismo , Exantema/etiologia , Humanos , Hipóxia/metabolismo , Masculino , Óxido Nítrico/metabolismo , Hipertensão Arterial Pulmonar/diagnóstico , Hipertensão Arterial Pulmonar/metabolismo , Fatores de Transcrição/metabolismo , Vitaminas/uso terapêuticoRESUMO
PURPOSE: To assess the role of high-flow nasal therapy (HFNT) compared to standard oxygen (SO) as complementary therapy to non-invasive ventilation (NIV). METHODS: Multicenter trial including patients (nâ¯=â¯54) anticipated to receive NIV for ≥24â¯h due to acute or acute-on-chronic respiratory failure. Subjects were randomized (1:1) to SO or HFNT during breaks off NIV. Primary outcome was total time on and off NIV. Secondary outcomes were comfort and dyspnea, respiratory rate (RR), oxygen saturation (SpO2), tolerance and side effects. RESULTS: Total time per patient on NIV (1315 vs 1441â¯min) and breaks (1362 vs 1196â¯min), and mean duration of each break (520 vs 370â¯min) were similar in the HFNT and SO arms (pâ¯>â¯.05). Comfort score was higher on HFNT than on SO (8.3⯱â¯2.7 vs 6.9⯱â¯2.3, pâ¯=â¯.001). Dyspnea, RR and SpO2 were similar in the two arms, but the increase in RR and dyspnea seen with SO during breaks did not occur with HFNT. CONCLUSION: Compared to SO, HFNT did not reduce time on NIV. However, it was more comfortable and the increase in RR and dyspnea seen with SO did not occur with HFNT. Therefore, HFNT could be a suitable alternative to SO during breaks off NIV.