RESUMEN
Introduction: Patients suffering from a neuromuscular disease have a greater likelihood of postoperative respiratory failure. Sometimes, this complication does not respond to noninvasive mechanical ventilation. Case report: Perioperative management of a patient with Werdnig-Hoffmann disease who underwent bilateral coronoidectomy due to trismus. The postoperative period was hampered by the patient's poor respiratory mechanics, inducing the appearance of atelectasis. Despite the application of preventive non-invasive mechanical ventilation, the patient suffered respiratory failure and required endotracheal intubation. Finally, the respiratory weaning was achieved after the application of insufflation-exsufflation devices associated with non-invasive mechanical ventilation. Conclusion: The application of insufflations-exsufflation devices in the immediate postoperative period of patients with neuromuscular diseases promotes the proper respiratory evolution of a patient considered impossible to extubate.
Introducción: El padecimiento de una enfermedad neuromusculares un factor predictor independiente de insuficiencia respiratoria postoperatoria. Esta complicación en ocasiones no responde al tratamiento con ventilación mecánica no invasiva. Presentación del caso: Manejo perioperatorio de un paciente con enfermedad de Werdnig-Hoffmann que fue intervenido de coronoidectomía bilateral por trismus. Su evolución postoperatoria se vio dificultada por la mala mecánica respiratoria del paciente que favoreció la aparición de atelectasias. A pesar de la aplicación de ventilación mecánica no invasiva de forma preventiva, el paciente terminó sufriendo insuficiencia respiratoria y requiriendo intubación orotraqueal. Finalmente se logra el destete respiratorio tras la aplicación de dispositivos de insuflación-exsuflación asociados a la ventilación mecánica no invasiva. Conclusión: La aplicación de los dispositivos de insuflación-exsuflación en el postoperatorio inmediato de pacientes con enfermedades neuromusculares favorece la adecuada evolución respiratoria de un paciente considerado inicialmente como imposible de extubar.
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HumanosRESUMEN
OBJECTIVE: Pulmonary arterial hypertension (PAH) prevalence has been reported to be between 0.5% and 17% in systemic lupus erythematosus (SLE). This study assessed PAH prevalence and predictors in an SLE cohort. METHODS: The Borg dyspnea scale, DLCO, N-terminal pro-brain natriuretic peptide (NT-proBNP), and Doppler echocardiographic (DE) were performed. An echocardiographic Doppler exercise test was conducted in selected patients. When DE systolic pulmonary arterial pressure was ≥ 45 mmHg or increased during exercise > 20 mmHg, a right heart catheterization was performed. Hemodynamic during exercise was measured if rest mean pulmonary arterial pressure was < 25 mmHg. RESULTS: Of the 203 patients with SLE, 152 were included. The mean age was 44.9 ± 12.3 years, and 94% were women. Three patients had known PAH. The algorithm diagnosed 1 patient with chronic thromboembolic pulmonary hypertension and 5 with exercise-induced pulmonary artery pressure increase (4 with occult left diastolic dysfunction). These patients had significantly more dyspnea, higher NT-proBNP, and lower DLCO. CONCLUSION: These data confirm the low prevalence of PAH in SLE. In our cohort, occult left ventricular diastolic dysfunction was a frequent diagnosis of unexplained dyspnea. Dyspnea, DLCO, and NT-proBNP could be predictors of pulmonary hypertension in patients with SLE.