Relación entre la movilidad diafragmática medida por ecografía y la presión parcial arterial de CO2 en pacientes con insuficiencia respiratoria aguda hipercápnica tras el inicio de la ventilación mecánica no invasiva en urgencias / Relation between ultrasound-measured diaphragm movement and partial pressure of carbon dioxide in blood from patients with acute hypercapnic respiratory failure after the start of noninvasive ventilation in an emergency department

Objetivo: Correlacionar la variación de la movilidad diafragmática (MD), medida a través de ecografía, con el cambio en la presión parcial arterial de CO2 de (pCO2) tras el inicio de la ventilación mecánica no invasiva (VMNI). Método: Estudio descriptivo de una serie de casos prospectivo que incluyó por oportunidad a los pacientes de 18 o más años con insuficiencia respiratoria hipercápnica en los que se inició la VMNI en urgencias. Se recogieron variables clínicas, gasométricas y mediciones ecográficas de la MD directa (MDD) y MD portal (MDP). Resultados: Se incluyeron 21 pacientes, con una edad media de 83 (DE 13) años, de ellos 11 mujeres (52,4%). Los valores de MDD y pCO2 fueron: 1) basal: MDD 13,9 (DE 7,7) mm y pCO2 71,7 (DE: 11,4) mmHg; 2) 15 minutos: MDD 17,1 (DE 9,1) mm; 3) 1 hora: MDD 22,4 (DE 10,4) y pCO2 63,4 (DE: 16,0) mmHg; 4) 3 horas: MDD 26,6 (DE: 19,5) mm y pCO2 61,8 (DE :13,0) mmHg. Hubo correlación estadísticamente significativa entre la diferencia a los 15 minutos y basal de MDD y el descenso a la hora de pCO2 (r = -0,489; p = 0,035). Conclusión: El aumento de la MDD a los 15 minutos del inicio de la VMNI se relaciona con una disminución de la pCO2 a la hora en los pacientes con insuficiencia respiratoria hipercápnica (AU)

Objective: To evaluate the correlation between variations in ultrasound-measured diaphragm movement and changes in the arterial partial pressure of carbon dioxide (PCO2) after the start of noninvasive ventilation (NIV). Methods: Descriptive study of a prospective case series comprised of nonconsecutive patients aged 18 years or older with hypercapnic respiratory failure who were placed on NIV in an emergency department. We recorded clinical data, blood gas measurements, and ultrasound measurements of diaphragm movement. Results: Twenty-one patients with a mean (SD) age of 83 (13) years were studied; 11 (52.4%) were women. The mean (SD) range of diaphragm movement and PCO2 values at 4 moments were as follows: 1) at baseline: diaphragm movement, 13.90 (7.7) mm and PCO2, 71.75 (11.4) mm Hg; 2) after 15 minutes on NIV: diaphragm movement, 17.10 (9.1) mm; 3) at 1 hour: diaphragm movement, 22.40 (10.4) mm and PCO2, 63.45 (16.0) mm Hg; and 4) at 3 hours: diaphragm movement, 26.60 (19.5) mm and PCO2, 61.85 (13.0) mm Hg. We detected a statistically significant correlation between the difference in range of diaphragm movement at baseline and at 15 minutes and the decrease in PCO2 after 1 hour of NIV (r=-0.489, P=.035). Conclusion: In patients with hypercapnic respiratory failure, the increase in range of diaphragm movement 15 minutes after starting NIV is associated with a decrease in PCO2 after 1 hour (AU)

[Relation between ultrasound-measured diaphragm movement and partial pressure of carbon dioxide in blood from patients with acute hypercapnic respiratory failure after the start of noninvasive ventilation in an emergency department]. / Relación entre la movilidad diafragmática medida por ecografía y la presión parcial arterial de CO2 en pacientes con insuficiencia respiratoria aguda hipercápnica tras el inicio de la ventilación mecánica no invasiva en urgencias.

OBJECTIVES: To evaluate the correlation between variations in ultrasound-measured diaphragm movement and changes in the arterial partial pressure of carbon dioxide (PCO2) after the start of noninvasive ventilation (NIV). MATERIAL AND METHODS: RDescriptive study of a prospective case series comprised of nonconsecutive patients aged 18 years or older with hypercapnic respiratory failure who were placed on NIV in an emergency department. We recorded clinical data, blood gas measurements, and ultrasound measurements of diaphragm movement. RESULTS: Twenty-one patients with a mean (SD) age of 83 (13) years were studied; 11 (52.4%) were women. The mean (SD) range of diaphragm movement and PCO2 values at 4 moments were as follows: 1) at baseline: diaphragm movement, 13.90 (7.7) mm and PCO2, 71.75 (11.4) mm Hg; 2) after 15 minutes on NIV: diaphragm movement, 17.10 (9.1) mm; 3) at 1 hour: diaphragm movement, 22.40 (10.4) mm and PCO2, 63.45 (16.0) mm Hg; and 4) at 3 hours: diaphragm movement, 26.60 (19.5) mm and PCO2, 61.85 (13.0) mm Hg. We detected a statistically significant correlation between the difference in range of diaphragm movement at baseline and at 15 minutes and the decrease in PCO2 after 1 hour of NIV (r=-0.489, P=.035). CONCLUSION: In patients with hypercapnic respiratory failure, the increase in range of diaphragm movement 15 minutes after starting NIV is associated with a decrease in PCO2 after 1 hour.

OBJETIVO: Correlacionar la variación de la movilidad diafragmática (MD), medida a través de ecografía, con el cambio en la presión parcial arterial de CO2 de (pCO2) tras el inicio de la ventilación mecánica no invasiva (VMNI). METODO: Estudio descriptivo de una serie de casos prospectivo que incluyó por oportunidad a los pacientes de 18 o más años con insuficiencia respiratoria hipercápnica en los que se inició la VMNI en urgencias. Se recogieron variables clínicas, gasométricas y mediciones ecográficas de la MD directa (MDD) y MD portal (MDP). RESULTADOS: Se incluyeron 21 pacientes, con una edad media de 83 (DE 13) años, de ellos 11 mujeres (52,4%). Los valores de MDD y pCO2 fueron: 1) basal: MDD 13,9 (DE 7,7) mm y pCO2 71,7 (DE: 11,4) mmHg; 2) 15 minutos: MDD 17,1 (DE 9,1) mm; 3) 1 hora: MDD 22,4 (DE 10,4) y pCO2 63,4 (DE: 16,0) mmHg; 4) 3 horas: MDD 26,6 (DE: 19,5) mm y pCO2 61,8 (DE :13,0) mmHg. Hubo correlación estadísticamente significativa entre la diferencia a los 15 minutos y basal de MDD y el descenso a la hora de pCO2 (r = ­0,489; p = 0,035). CONCLUSIONES: El aumento de la MDD a los 15 minutos del inicio de la VMNI se relaciona con una disminución de la pCO2 a la hora en los pacientes con insuficiencia respiratoria hipercápnica.

Effects of nifedipine, verapamil and diltiazem on serum biochemical parameters and aortic composition of atherosclerotic chickens.

Calcium appears to be involved in many of the cellular events, which are thought to be important in atherogenesis. In this study, we examine the effects of three calcium entry blockers (nifedipine, verapamil, and diltiazem at clinical and higher doses) on serum biochemical parameters and aortic calcium, cholesterol and triglyceride concentrations of atherosclerotic egg-fed chickens. All egg-fed chickens (treated and non-treated) showed an increase in serum total cholesterol, LDL-cholesterol and triglycerides without significant effect when calcium entry blockers were used. Increased HDL values were observed in clinical and high-dose nifedipine and clinical dose verapamil groups. The high-dose diltiazem group presented increased zinc values with respect to the clinical dose diltiazem and control groups. The sodium concentrations were significantly decreased in all the groups of animals treated with calcium entry blockers at high-doses and nifedipine at clinical doses. Measurements of aortic calcium concentration showed a significant decrease in the high-dose nifedipine and verapamil groups. Calcium channel blockers had a tendency to decrease total cholesterol in aortas. The values were statistically significant for the high-dose verapamil, and nifedipine groups. Only nifedipine showed a significant decrease for this parameter at clinical dosages. Triglyceride concentrations in aortas were significantly low in animals fed an atherogenic diet and treated with calcium channel blockers, without differences between drugs or dosages used in the experiment. In addition, the chicken atherosclerosis model has proved itself useful and very suitable for in vivo drug intervention studies.