<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932024000100051</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2024.e11142403</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Falla en la extubación en el paciente con trauma raquimedular: parálisis diafragmática. Una entidad por considerar]]></article-title>
<article-title xml:lang="en"><![CDATA[Extubation failure in the patient with spinal cord trauma: diaphragmatic paralysis. An entity to consider]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Serna-Trejos]]></surname>
<given-names><![CDATA[Juan Santiago]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bermúdez-Moyano]]></surname>
<given-names><![CDATA[Stefanya Geraldine]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Diaz-Beltran]]></surname>
<given-names><![CDATA[Juan Camilo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zafra-Florez]]></surname>
<given-names><![CDATA[Andrés Felipe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Clínica Imbanaco  ]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Universitario del Valle  ]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Militar Central  ]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>11</volume>
<numero>1</numero>
<fpage>51</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932024000100051&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932024000100051&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932024000100051&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN La parálisis diafragmática es una entidad con epidemiologia no constatada, sin embargo, debe considerarse en el paciente con antecedente de trauma raquimedular asociado que presente signos tempranos de dificultad respiratoria, para de esta forma investigar y ofrecer manejos oportunos en esta condición clínica. Se presenta caso de varón de 65 años con debilidad diafragmática crónica por antecedente de herida por arma de fuego a nivel de la columna cervical.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Diaphragmatic paralysis is an entity with an unproven epidemiology. However, it should be considered in patients with a history of associated spinal cord trauma who present early signs of respiratory difficulty, to investigate and offer timely management to this clinical condition. We present the case of a 65-year-old man with chronic diaphragmatic weakness due to a history of gunshot wounds at the level of the cervical spine.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[parálisis diafragmática]]></kwd>
<kwd lng="es"><![CDATA[parálisis respiratoria]]></kwd>
<kwd lng="es"><![CDATA[intubación intratraqueal]]></kwd>
<kwd lng="es"><![CDATA[fracturas de la columna vertebral]]></kwd>
<kwd lng="es"><![CDATA[traumatismos de la médula espinal]]></kwd>
<kwd lng="es"><![CDATA[parálisis de músculos respiratorios]]></kwd>
<kwd lng="en"><![CDATA[diaphragmatic paralysis]]></kwd>
<kwd lng="en"><![CDATA[respiratory paralysis]]></kwd>
<kwd lng="en"><![CDATA[intratracheal intubation]]></kwd>
<kwd lng="en"><![CDATA[fractures of the spine]]></kwd>
<kwd lng="en"><![CDATA[spinal cord trauma]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gáldiz Iturri]]></surname>
<given-names><![CDATA[JB]]></given-names>
</name>
<name>
<surname><![CDATA[Gorostiza Manterola]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Enfermedades del diafragma]]></article-title>
<source><![CDATA[Neumología clínica]]></source>
<year>2010</year>
<edition>1a. Ed</edition>
<page-range>692-8</page-range><publisher-loc><![CDATA[España ]]></publisher-loc>
<publisher-name><![CDATA[Elsevier]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Onders]]></surname>
<given-names><![CDATA[RP]]></given-names>
</name>
<name>
<surname><![CDATA[Elmo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kaplan]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Katirji]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Schilz]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Extended use of diaphragm pacing in patients with unilateral or bilateral diaphragm dysfunction]]></article-title>
<source><![CDATA[Surgery]]></source>
<year>2014</year>
<volume>156</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>776-84</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Carrillo Esper]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez Calatayud]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<name>
<surname><![CDATA[Peña Pérez]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluación ultrasonográfica de la función diafragmática mediante doble abordaje en el paciente grave]]></article-title>
<source><![CDATA[Rev Asoc Mex Med Crit Ter Intensiva]]></source>
<year>2016</year>
<volume>30</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>242-5</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ricoy]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez-Núñez]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Álvarez-Dobaño]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Toubes]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Riveiro]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Valdés]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diaphragmatic dysfunction]]></article-title>
<source><![CDATA[Pulmonology]]></source>
<year>2019</year>
<volume>25</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>223-35</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Göhl]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Walker]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
<name>
<surname><![CDATA[Walterspacher]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Langer]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Spengler]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Wanke]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Respiratory muscle training]]></article-title>
<source><![CDATA[State of the art. Pneumologie]]></source>
<year>2016</year>
<volume>70</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>37-48</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hardavella]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Karampinis]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Frille]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Sreter]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Rousalova]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Oxygen devices and delivery systems]]></article-title>
<source><![CDATA[Breathe]]></source>
<year>2019</year>
<volume>15</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>e108-16</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[van den Biggelaar]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Hazenberg]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Duiverman]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The role of telemonitoring in patients on home mechanical ventilation]]></article-title>
<source><![CDATA[Eur Respir Rev]]></source>
<year>2023</year>
<volume>32</volume>
<numero>168</numero>
<issue>168</issue>
<page-range>220207</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Windisch]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Schönhofer]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Magnet]]></surname>
<given-names><![CDATA[FS]]></given-names>
</name>
<name>
<surname><![CDATA[Stoelben]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Kabitz]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis and Treatment of Diaphragmatic Dysfunction]]></article-title>
<source><![CDATA[Pneumologie]]></source>
<year>2016</year>
<volume>70</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>454-61</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Liu]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Schafer]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Mao]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Goshgarian]]></surname>
<given-names><![CDATA[HG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diaphragmatic recovery in rats with cervical spinal cord injury induced by a theophylline nanoconjugate]]></article-title>
<source><![CDATA[J Spinal Cord Med]]></source>
<year>2019</year>
<volume>42</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>725-34</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Koopman]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Vanfleteren]]></surname>
<given-names><![CDATA[LEGW]]></given-names>
</name>
<name>
<surname><![CDATA[Steijns]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Wouters]]></surname>
<given-names><![CDATA[EFM]]></given-names>
</name>
<name>
<surname><![CDATA[Sprooten]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Increased exercise tolerance using daytime mouthpiece ventilation for patients with diaphragm paralysis]]></article-title>
<source><![CDATA[Breathe]]></source>
<year>2017</year>
<volume>13</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>225-9</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kaufman]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Elkwood]]></surname>
<given-names><![CDATA[AI]]></given-names>
</name>
<name>
<surname><![CDATA[Colicchio]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[Cece]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Jarrahy]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Willekes]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Functional restoration of diaphragmatic paralysis: an evaluation of phrenic nerve reconstruction]]></article-title>
<source><![CDATA[Ann Thorac Surg]]></source>
<year>2014</year>
<volume>97</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>260-6</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Harris]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Maniatis]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Siddiqui]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Maniatis]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Phrenic nerve injury and diaphragmatic paralysis following pacemaker pulse generator replacement]]></article-title>
<source><![CDATA[Hear Lung]]></source>
<year>2013</year>
<volume>42</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>65-6</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kaufman]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Bauer]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Onders]]></surname>
<given-names><![CDATA[RP]]></given-names>
</name>
<name>
<surname><![CDATA[Brown]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
<name>
<surname><![CDATA[Chang]]></surname>
<given-names><![CDATA[EI]]></given-names>
</name>
<name>
<surname><![CDATA[Rossi]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Treatment for bilateral diaphragmatic dysfunction using phrenic nerve reconstruction and diaphragm pacemakers.]]></article-title>
<source><![CDATA[Interact Cardiovasc Thorac Surg]]></source>
<year>2021</year>
<volume>32</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>753-60</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
