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2.
Rev. esp. anestesiol. reanim ; 66(6): 342-345, jun.-jul. 2019.
Artigo em Espanhol | IBECS | ID: ibc-187544

RESUMO

La colecistectomía laparoscópica supone hoy en día el tratamiento gold estándar de la patología aguda de la vía biliar. A pesar de las numerosas ventajas que presenta respecto a la cirugía abierta clásica, no está exenta de complicaciones. Presentamos el caso de un paciente varón de 82 años que tras el diagnóstico de colecistitis gangrenosa es intervenido de urgencia de colecistectomía laparoscópica, presentando en las primeras 24h del postoperatorio un episodio de insuficiencia respiratoria aguda, motivo por el cual ingresa en reanimación. Los estudios realizados a posteriori mostraron una parálisis del hemidiafragma derecho, probablemente relacionada con la cirugía


Laparoscopic cholecystectomy is currently the gold standard treatment for acute biliary tract pathology. Despite its many advantages compared to open surgery, it is not without complications. We present the case of an 82-year-old man who, after a diagnosis of gangrenous cholecystitis, underwent urgent laparoscopic cholecystectomy. During the first 24hours after the surgery, he had an episode of acute respiratory failure, for which he was admitted to the critical care unit. Studies performed later showed paralysis of the right diaphragm that was probably related to the surgery


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Paralisia Respiratória/etiologia , Colecistectomia Laparoscópica/efeitos adversos , Colecistite/cirurgia , Insuficiência Respiratória/etiologia , Reanimação Cardiopulmonar , Nervo Frênico/fisiopatologia , Pneumoperitônio/complicações , Apraxias/etiologia
4.
Pediatr Pulmonol ; 54(9): 1367-1373, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31211516

RESUMO

Diaphragmatic paralysis (DP) is a rare cause of respiratory distress in young children. In the first years of life, the main cause is phrenic nerve injury after cardiothoracic surgery or obstetrical trauma. DP usually presents as respiratory distress. Asymmetrical thorax elevation, difficulty weaning from mechanical ventilation, pulmonary atelectasis, and repeated pulmonary infections are other suggestive signs or complications. DP is usually suspected on chest X-ray showing abnormal hemidiaphragm elevation. Although fluoroscopy was considered the gold standard for DP confirmation, it has gradually been replaced by ultrasound, which can be done at the bedside. Some electrophysiological tools may be useful for a better characterization of phrenic nerve injury and chance of recovery. The management of DP is mainly based on clinical severity. In mild asymptomatic cases, DP may only require close monitoring. In more severe cases, adequate ventilatory support and/or surgical diaphragmatic plication may be needed. Electrophysiological tools may help clinicians assess the ideal timing for diaphragmatic plication.


Assuntos
Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Paralisia Respiratória , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Eletrodiagnóstico , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/terapia , Radiografia Torácica , Respiração Artificial , Insuficiência Respiratória/etiologia , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologia , Paralisia Respiratória/terapia
5.
Medicina (Kaunas) ; 55(5)2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31117219

RESUMO

Background and objectives: Bilateral facial paralysis is a rare and specific clinical manifestation of various neurological disorders. Bilateral facial paralysis has been reported as an essential feature of Guillain-Barré syndrome (GBS) for many years. We aim to describe the incidence of bilateral facial paralysis and prognosis in our GBS patients. Materials and Methods: A retrospective chart review of all patients with GBS and bilateral facial paralysis who were treated at the Inönü University Medical Faculty was performed. Results: A total of 45 cases of GBS were reviewed. Four out of 45 patients (8.8%) had associated bilateral facial paralysis. Only one of the patients also had acute multiple cranial neuropathies. All patients experienced sudden deterioration and respiratory distress. In one of our patients who had multiple cranial neuropathies, serum antiganglioside antibody assay was performed, and anti-GQ1b IgG antibody positivity was observed. The cerebrospinal fluid had albuminocytological dissociation in all patients, and axonal involvement was present in nerve conduction studies (NCS). Three patients improved with immunotherapy; one patient died due to cardiac arrest after resistant hypotension. Conclusion: Bilateral facial paralysis is a rare condition in children. We wanted to emphasize bilateral facial involvement and poor prognosis in our GBS patients.


Assuntos
Paralisia Facial/complicações , Síndrome de Guillain-Barré/complicações , Paralisia Respiratória/etiologia , Adolescente , Criança , Paralisia Facial/etiologia , Feminino , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Masculino , Condução Nervosa , Estudos Retrospectivos , Turquia
6.
Eur J Anaesthesiol ; 36(6): 427-435, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31045699

RESUMO

BACKGROUND: Interscalene brachial plexus blockade is the most common regional anaesthesia technique for alleviating pain after shoulder surgery, but complications occur, including ipsilateral hemidiaphragmatic paresis, Horner's syndrome and hoarseness. The supraclavicular approach might be an effective alternative with fewer adverse effects. OBJECTIVES: The aim of this study was to determine whether there is a difference in postoperative pain scores and morphine equivalents between interscalene and supraclavicular brachial plexus blocks. Secondary endpoints were serious adverse events. DESIGN: A systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: A comprehensive literature search of Embase, CENTRAL, MEDLINE and Web of Science was performed from the earliest record to December 2018. ELIGIBILITY CRITERIA: Prospective randomised controlled trials that compare interscalene and supraclavicular brachial plexus blocks in patients undergoing shoulder surgery were eligible for inclusion. Only studies that reported their methods transparently and comprehensibly were included. Conference abstracts or meeting abstracts were not excluded a priori. Risk of bias was assessed using Cochrane methodology. RESULTS: Twelve studies were eligible for meta-analysis. The supraclavicular approach showed overall comparable 24-h pain scores (mean difference -0.34; 95% CI -0.75 to 0.07, P = 0.11) and comparable morphine equivalent consumption (mean difference 1.84 mg per 24 h; 95% CI -0.00 to 3.69, P = 0.05). Secondary endpoint analysis revealed a significantly lower rate of hemidiaphragmatic paresis (risk ratio 0.56; 95% CI 0.39 to 0.82, P = 0.003) and Horner's syndrome (risk ratio 0.29; 95% CI 0.19 to 0.44, P < 0.00001) for the supraclavicular approach. There was no significant difference in hoarseness (risk ratio 0.73; 95% CI 0.48 to 1.13, P = 0.16). CONCLUSION: After 24 postoperative hours, pain scores and consumption of morphine equivalents were comparable. Adverse effects were less common with the supraclavicular approach. The supraclavicular approach might be an efficient alternative to the interscalene approach for shoulder surgery. However, the available evidence is inadequate and prevents a firm conclusion.


Assuntos
Bloqueio do Plexo Braquial/métodos , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Articulação do Ombro/cirurgia , Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial/efeitos adversos , Rouquidão/epidemiologia , Rouquidão/etiologia , Síndrome de Horner/epidemiologia , Síndrome de Horner/etiologia , Humanos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Paralisia Respiratória/epidemiologia , Paralisia Respiratória/etiologia
7.
Rev Mal Respir ; 36(2): 197-203, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30711345

RESUMO

INTRODUCTION: Lyme disease is not uncommon and can sometimes progress to neurological complications. We report here an unusual case of bilateral diaphragmatic paralysis secondary to Lyme neuroborreliosis. CASE REPORT: A 79-year-old man was admitted to the intensive care unit for acute respiratory distress requiring intubation and the long-term use of nocturnal non-invasive ventilation. Three months beforehand he had been bitten by a tick and developed erythema migrans which was treated with Doxycycline for 10 days. This clinical presentation became complicated a few days later by the progressive onset of severe dyspnoea. At admission, chest radiography revealed bilateral elevation of the diaphragm. Pulmonary function tests revealed a severe restrictive disorder aggravated by decubitus. A diaphragmatic electromyogram showed bilateral axonal polyneuropathy of the phrenic nerves. IgG and IgM antibodies to Borrelia burgdorferi were detectable in serum and cerebrospinal fluid, leading to the diagnosis of Lyme disease. He was treated with intravenous ceftriaxone 2g per day for 21 days, leading to a substantial improvement in symptoms. CONCLUSION: In the presence of unilateral or bilateral diaphragmatic paralysis of undetermined aetiology, it seems relevant to perform Lyme serology in the blood and, in positive cases, to follow up with a lumbar puncture in order to detect intrathecal IgG synthesis.


Assuntos
Neuroborreliose de Lyme/complicações , Síndrome do Desconforto Respiratório do Adulto/etiologia , Paralisia Respiratória/etiologia , Idoso , Grupo Borrelia Burgdorferi/efeitos dos fármacos , Grupo Borrelia Burgdorferi/isolamento & purificação , Ceftriaxona/uso terapêutico , Doxiciclina/uso terapêutico , Humanos , Neuroborreliose de Lyme/diagnóstico , Neuroborreliose de Lyme/tratamento farmacológico , Masculino , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/tratamento farmacológico
8.
Am J Emerg Med ; 37(9): 1611-1617, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30527914

RESUMO

OBJECTIVE: Organophosphate (OP) pesticides are still widely available in developing countries, leading to numerous accidental or suicidal poisonings every year. Lipid emulsion treatments are commonly used in resuscitating OP poisoning patients but few studies regarding their use have been reported. Our meta-analysis aimed to analyze the efficacy and outcomes of lipid resuscitation on OP poisoning patients. METHODS: A systematic search for associated studies was conducted in Pubmed, EMBASE, MEDLINE, the Cochrane Library and the Chinese National Knowledge Infrastructure. Collected data was pooled using Revman v5.3. Outcomes included prognosis (cured vs. mortality rates), hepatic function (serum ALT, AST, Total Bilirubin (TBIL) level), serum acetylcholinesterase (AchE) level and respiratory function (rate of respiratory muscular paralysis). RESULTS: Seven randomized controlled studies consisting of 630 patients meeting inclusion criteria were identified. Lipid emulsion helped to improve the cure rate [OR = 2.54, 95% CI (1.33, 4.86), p = 0.005] and lower the mortality rate [OR = 0.31, 95% CI (0.13, 0.74), p = 0.009]. Serum ALT, AST and TBIL in patients undergoing lipid resuscitation were lower than those in the control groups [ALT, SMD = -1.52, 95% CI (-2.64, 0.40), p = 0.008; AST, SMD = -1.66, 95% CI (-3.15, 0.16), p = 0.03; TBIL, SMD = -1.26, 95% CI (-2.32, 0.20), p = 0.02]. Serum AchE level were increased in patients treated with lipid emulsion [SMD = 2.15, 95% CI (1.60, 2.71), p < 0.00001]. Rate of respiratory muscular paralysis was lower in patients undergoing lipid resuscitation than those in the control groups [OR = 0.19, 95% CI (0.05, 0.71), p = 0.01]. CONCLUSION: Based on our meta-analysis of included RCT reports, lipid resuscitation seems likely to help improve prognosis and liver function of OP poisoning patients. However, larger multi-center RCTs are still recommended.


Assuntos
Emulsões Gordurosas Intravenosas/uso terapêutico , Intoxicação por Organofosfatos/terapia , Ressuscitação/métodos , Acetilcolinesterase/sangue , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Humanos , Mortalidade , Intoxicação por Organofosfatos/complicações , Paralisia Respiratória/etiologia , Resultado do Tratamento
9.
Pulmonology ; 25(4): 223-235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30509855

RESUMO

The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres. This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.


Assuntos
Diafragma/fisiopatologia , Nervo Frênico/fisiopatologia , Paralisia Respiratória/terapia , Ultrassonografia/métodos , Diafragma/diagnóstico por imagem , Diafragma/inervação , Diafragma/cirurgia , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/fisiopatologia , Fluoroscopia/métodos , Humanos , Microcirurgia/métodos , Nervo Frênico/lesões , Nervo Frênico/patologia , Nervo Frênico/cirurgia , Radiografia/métodos , Respiração Artificial/métodos , Respiração Artificial/tendências , Testes de Função Respiratória/métodos , Paralisia Respiratória/etiologia , Estimulação Elétrica Nervosa Transcutânea/métodos
11.
Am J Med Sci ; 357(3): 263-267, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30578021

RESUMO

Pseudocholinesterase deficiency is a rare genetic as well as an acquired disorder that affects the body's ability to metabolize choline esters such as succinylcholine and mivacurium. It can be inherited as an autosomal recessive trait, occurring in approximately 1 in 3,200 to 1 in 5,000 people. In most cases of pseudocholinesterase deficiency, no signs or symptoms of the condition exist. It is first suspected after a prolonged recovery from paralysis following general anesthesia in which succinylcholine or mivacurium are administered. We emphasize the importance of obtaining a detailed history prior to any endoscopic intervention or surgery requiring monitored anesthesia care or general anesthesia. In addition, a family history of anesthesia complications may help identify patients at risk. This article examines a case of a patient who underwent a successful endoscopic pneumatic dilation under general anesthesia for the treatment of achalasia, but was subsequently admitted to the intensive care unit, requiring mechanical ventilator support, for 18 hours. The patient made a complete recovery and was discharged home with no further complications. This case stimulated a review of this entity and we provide recommendations relevant to all proceduralist and anesthesia staff, as well as all personnel involved in procedures.


Assuntos
Apneia , Butirilcolinesterase/deficiência , Acalasia Esofágica , Erros Inatos do Metabolismo , Respiração Artificial/métodos , Paralisia Respiratória , Succinilcolina , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Apneia/complicações , Apneia/diagnóstico , Apneia/metabolismo , Butirilcolinesterase/metabolismo , Dilatação/métodos , Endoscopia/métodos , Acalasia Esofágica/fisiopatologia , Acalasia Esofágica/cirurgia , Humanos , Masculino , Erros Inatos do Metabolismo/complicações , Erros Inatos do Metabolismo/diagnóstico , Erros Inatos do Metabolismo/metabolismo , Pessoa de Meia-Idade , Fármacos Neuromusculares Despolarizantes/administração & dosagem , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Paralisia Respiratória/etiologia , Paralisia Respiratória/terapia , Succinilcolina/administração & dosagem , Succinilcolina/efeitos adversos , Resultado do Tratamento
13.
BMJ Case Rep ; 20182018 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-30269091

RESUMO

In this case report, we describe the course of a female patient who is known to have neuromyelitis optica (NMO) and developed left hemiparesis and unilateral diaphragmatic paralysis. She was initially treated with intravenous methylprednisolone 1 g daily for 5 days without improvement. Subsequently, she received five sessions of a plasmapheresis. Her hemiparesis had improved after few days. however, the phrenic nerve palsy remained.


Assuntos
Neuromielite Óptica/complicações , Paralisia Respiratória/etiologia , Adulto , Autoanticorpos/sangue , Biomarcadores/sangue , Progressão da Doença , Feminino , Humanos , Metilprednisolona/administração & dosagem , Neuromielite Óptica/fisiopatologia , Paresia/diagnóstico , Plasmaferese , Paralisia Respiratória/terapia , Prevenção Secundária/métodos
14.
J Cardiothorac Surg ; 13(1): 98, 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-30257688

RESUMO

BACKGROUND: Diaphragmatic plication to help ventilation weaning of an adult obese patient after cardiac surgery is very uncommon. Diaphragm paralysis is usually treated with conservative measures and ventilator support, after which surgical management is considered after months of medical monitoring. CASE PRESENTATION: We report the case of a morbidly obese patient to whom ventilation weaning was unsuccessful following coronary artery bypass graft operation with mitral valve replacement. A de novo right hemidiaphragm elevation was seen on the chest X-ray. Diaphragmatic plication was performed promptly to treat severe respiratory insufficiency and generated favorable outcomes. CONCLUSIONS: Early diaphragmatic plication could be considered in the postoperative period of cardiothoracic surgery to facilitate management and ventilation weaning in the context of de novo diaphragm paralysis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Diafragma/cirurgia , Obesidade Mórbida/complicações , Complicações Pós-Operatórias , Paralisia Respiratória/cirurgia , Idoso , Humanos , Masculino , Reoperação , Paralisia Respiratória/etiologia , Desmame do Respirador
15.
Chest ; 154(6): 1395-1403, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30144420

RESUMO

The diaphragm is the primary muscle of inspiration. Its capacity to respond to the load imposed by pulmonary disease is a major determining factor both in the onset of ventilatory failure and in the ability to successfully separate patients from ventilator support. It has recently been established that a very large proportion of critically ill patients exhibit major weakness of the diaphragm, which is associated with poor clinical outcomes. The two greatest risk factors for the development of diaphragm weakness in critical illness are the use of mechanical ventilation and the presence of sepsis. Loss of force production by the diaphragm under these conditions is caused by a combination of defective contractility and reduced diaphragm muscle mass. Importantly, many of the same molecular mechanisms are implicated in the diaphragm dysfunction associated with both mechanical ventilation and sepsis. This review outlines the primary cellular mechanisms identified thus far at the nexus of diaphragm dysfunction associated with mechanical ventilation and/or sepsis, and explores the potential for treatment or prevention of diaphragm weakness in critically ill patients through therapeutic manipulation of these final common pathway targets.


Assuntos
Estado Terminal , Administração dos Cuidados ao Paciente/métodos , Respiração Artificial/efeitos adversos , Paralisia Respiratória , Sepse/complicações , Humanos , Paralisia Respiratória/etiologia , Paralisia Respiratória/fisiopatologia , Paralisia Respiratória/terapia
18.
Rev Esp Anestesiol Reanim ; 65(10): 593-596, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30033043

RESUMO

Phrenic nerve block is a complication that can occur after brachial plexus anaesthesia above the clavicle. The main consequence of this blockage is ipsolateral diaphragmatic paralysis, which can sometimes lead to the appearance of post-operative respiratory complications. A case is presented on a woman, who after having undergone a total shoulder prosthesis, presented with dyspnoea in the post-operative recovery unit. A diaphragmatic ultrasound was performed that enabled a rapid diagnosis to be made of a complete paralysis of the ipsolateral hemi-diaphragm. Given the suspicion of phrenic nerve block, ultrasound has proven to be a rapid diagnostic tool with high sensitivity and specificity. Its use can anticipate the possible development of immediate complications, and act as a guide in choosing the appropriate therapeutic strategy for each case in an early manner. In this case it enabled us to treat early with oxygen therapy, interscalene catheter removal, and intensive surveillance.


Assuntos
Artroplastia do Ombro , Diafragma/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico , Nervo Frênico/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Paralisia Respiratória/diagnóstico , Idoso , Anestésicos Locais/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Remoção de Dispositivo , Dispneia/etiologia , Dispneia/terapia , Diagnóstico Precoce , Feminino , Humanos , Levobupivacaína/efeitos adversos , Oxigenoterapia , Doenças do Sistema Nervoso Periférico/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologia , Ultrassonografia
19.
Neurology ; 91(9): e843-e849, 2018 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-30054437

RESUMO

OBJECTIVE: To describe the clinical phenotype and recovery of diaphragm dysfunction caused by neuralgic amyotrophy in a large cohort of patients, to improve accurate awareness of this entity, and to encourage adoption of a standardized approach for diagnosis and treatment. METHODS: This observational cohort study recruited adult patients with neuralgic amyotrophy and symptoms of idiopathic phrenic neuropathy from the database of the Dutch expert center for neuralgic amyotrophy and the Dutch centers for home mechanical ventilation. Demographic and clinical information on diagnosis, symptoms, and recovery was obtained from chart review. We attempted to contact all patients for a follow-up interview. RESULTS: Phrenic neuropathy occurs in 7.6% of patients with neuralgic amyotrophy. Unilateral diaphragmatic dysfunction and bilateral diaphragmatic dysfunction are frequently symptomatic, causing exertional dyspnea, orthopnea, disturbed sleep, and excessive fatigue. Diagnostic practices varied widely and were often not optimally targeted. The majority of patients experienced at least moderate recovery within 2 years. CONCLUSION: We recommend screening every patient with neuralgic amyotrophy for diaphragm dysfunction by asking about orthopnea and by performing upright and supine vital capacity screening and diaphragm ultrasound in cases of suspected phrenic neuropathy to optimize diagnosis and care.


Assuntos
Neurite do Plexo Braquial/complicações , Neurite do Plexo Braquial/patologia , Diafragma/fisiopatologia , Nervo Frênico/fisiopatologia , Paralisia Respiratória/etiologia , Adolescente , Adulto , Idoso , Neurite do Plexo Braquial/epidemiologia , Neurite do Plexo Braquial/terapia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Recuperação de Função Fisiológica , Respiração Artificial/métodos , Adulto Jovem
20.
Cardiol Young ; 28(5): 776-778, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29490711

RESUMO

Diaphragm excursion method is unsuitable for diagnosis of diaphragm paralysis during positive pressure ventilation. We diagnosed diaphragm paralysis in a neonate, without interrupting positive pressure respiratory support after cardiac surgery, using the diaphragm thickness fraction, which could be evaluated during mechanical ventilation and was unaffected by bowel gases. The diaphragm thickness fraction method can help diagnose diaphragm dysfunction using only echography.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas/cirurgia , Respiração Artificial/efeitos adversos , Paralisia Respiratória/diagnóstico , Ultrassonografia/métodos , Humanos , Recém-Nascido , Masculino , Período Pós-Operatório , Paralisia Respiratória/etiologia
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