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Vol. 59. Núm. 5.
Páginas 483-490 (Noviembre 2003)
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Vol. 59. Núm. 5.
Páginas 483-490 (Noviembre 2003)
Acceso a texto completo
Tratamientos complementarios: óxido nítrico, posición en prono y surfactante
Complementary treatments: nitric oxide, prone positioning and surfactant
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...
I. Martos Sánchez*, J.L. Vázquez Martínez, E. Otheo de Tejada, P. Ros
Unidad de Cuidados Intensivos Pediátricos. Hospital Ramón y Cajal. Madrid. España
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Bibliografía
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El tratamiento del fracaso respiratorio hipoxémico se basa fundamentalmente en el aporte de oxígeno y en la utilización de la VM con la estrategia de “protección pulmonar”. Gracias a un mejor conocimiento de la fisiopatología de la lesión pulmonar aguda se han desarrollado otras estrategias que pueden modificar la evolución clínica de estos pacientes. Dichos tratamientos complementarios a la VM incluyen la administración de óxido nítrico (NO), surfactante y la VM en posición prono. El NO es un vasodilatador pulmonar selectivo que administrado de forma inhalada mejora la oxigenación en situaciones clínicas como la persistencia de la circulación fetal en el recién nacido, en la hipertensión pulmonar asociada a cardiopatías congénitas o en el síndrome de dificultad respiratoria aguda (SDRA). La posición en prono mejora la distribución de la ventilación y disminuye el cortocircuito intrapulmonar cuando se aplica de forma precoz en el SDRA. El surfactante ha disminuido de forma dramática la mortalidad de la enfermedad de la membrana hialina en el recién nacido prematuro, aunque en el SDRA no ha tenido resultados tan satisfactorios. Se necesita más experiencia para determinar si la combinación de estos tratamientos mejorarán el pronóstico.

Palabras clave:
Fracaso respiratorio hipoxémico
Óxido nítrico
Posición en prono
Surfactante
Niños
Síndrome de dificultad respiratoria aguda

The management of hypoxic respiratory failure is based on oxygen delivery and ventilatory support with lung-protective ventilation strategies. Better understanding of acute lung injury have led to new therapeutic approaches that can modify the outcome of these patients. These adjunctive oxygenation strategies include inhaled nitric oxide and surfactant delivery, and the use of prone positioning. Nitric oxide is a selective pulmonary vasodilator that, when inhaled, improves oxygenation in clinical situations such as persistent pulmonary hypertension of the newborn, pulmonary hypertension associated with congenital heart disease, and acute respiratory distress syndrome (ARDS). When applied early in ARDS, prone positioning improves distribution of ventilation and reduces the intrapulmonary shunt. The surfactant has dramatically decreased mortality caused by hyaline membrane disease in premature newborns, although the results have been less successful in ARDS. Greater experience is required to determine whether the combination of these treatments will improve the prognosis of these patients.

Key words:
Hypoxemic respiratory failure
Nitric oxide
Prone positioning
Surfactant
Children
Acute respiratory distress syndrome
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Bibliografía
[1.]
M. Francoe, E. Troncy, G. Blaise.
Inhaled nitric oxide. Technical aspects of administration and monitoring.
Crit Care Med, 26 (1998), pp. 782-796
[2.]
N.N. Finer, K.J. Barrington.
Nitric oxide for respiratory failure in infants born at or near term (Cochrane Review).
The Cochrane Library, Issue 2, (2002),
[3.]
R.H. Clark, T.J. Kueser, M.W. Walker, W.M. Southgate, J.L. Huckaby, J.A. Perez, et al.
For the Clinical Inhaled Nitric Oxide Research Group. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn.
N Engl J Med, 342 (2000), pp. 469-474
[4.]
The Neonatal Inhaled Nitric Oxide Study Group.
Inhaled Nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure.
N Engl J Med, 336 (1997), pp. 597-604
[5.]
American Academy of Pediatrics.
Committee on Fetus and Newborn. Use of Inhaled Nitric Oxide.
Pediatrics, 106 (2000), pp. 344-345
[6.]
R.P. Dellinger, J.L. Zimmerman, R.W. Taylor, R.C. Straube.
Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: Results of a randomized phase II trial.
Crit Care Med, 26 (1998), pp. 15-23
[7.]
G.L. Bloomfield, S. Holloway, P.C. Ridings, B.J. Fisher, C.R. Blocher, M. Sholley, et al.
Pretreatment with Inhaled Nitric Oxide inhibits neutrophil migration and oxidative activity resultin in attenuated sepsis-induced acute lung injury.
Crit Care Med, 25 (1997), pp. 584-593
[8.]
J. Sokol, S.E. Jacobs, D. Bohn.
Inhaled nitric oxide for acute hypoxemic respiratory failure in children and adults (Cochrane Review).
The Cochrane Library, Issue 2, (2002),
[9.]
J. López-Herce Cid, E. Cueto Calvo, A. Carrillo Álvarez, P. Vázquez, A. Bustinza, R. Moral.
Respuesta aguda a la administración de óxido nítrico en niños.
An Esp Pediatr, 46 (1997), pp. 581-586
[10.]
R.W. Day, M. Guarin, J.M. Lynch, D.D. Vernon, J.M. Dean.
Inhaled nitric oxide in children with severe lung disease: Results of acute and prolonged therapy with two concentrations.
Crit Care Med, 24 (1996), pp. 215-221
[11.]
E. Troncy, J.P. Collet, S. Shapiro.
Inhaled nitric oxide in acute respiratory distress syndrome: A pilot randomized controlled study.
Am J Respir Crit Care Med, 157 (1998), pp. 1483-1488
[12.]
M. Beghetti, W. Habre, B. Friedli, M. Berner.
Continuous low dose inhaled nitric oxide for treatment of severe pulmonary hypertension after cardiac surgery in paedatric patients.
Br Heart J, 73 (1995), pp. 65-68
[13.]
I. Schulze-Neick, M. Bultmann, H. Werner, A. Gamillscheg, M. Vogel, F. Berger, et al.
Right ventricular function in patients treated with inhaled nitric oxide after cardiac surgery for congenital Heart disease in newborn and children.
Am J Cardiol, 80 (1997), pp. 360-363
[14.]
S.J. Njohnston, S.A. Falkos, R.J. Gómez, A. Morris.
Life-treatening status asthmaticus treated with inhaled nitric oxide.
J Pediatr, 137 (2000), pp. 119-122
[15.]
E. Cueto, J. López-Herce, A. Sánchez, A. Carrillo.
Life-threatening effects of discontinuing inhaled nitric oxide in children.
Acta Paediatr, 86 (1997), pp. 1337-1339
[16.]
T. Bichel, I. Spahr-Schopfer, M. Berner, E. Jaeggi, Y. Velkovski, B. Friedli, et al.
Successful weaning from cardiopulmonary bypass after cardiac surgery using inhaled nitric oxide.
Paediatr Anaesth, 7 (1997), pp. 335-339
[17.]
D.L. Lee, H.T. Chiang, S.L. Lin, L.P. Ger, M.H. Kun, Y.C. Huang.
Prone-position ventilation induces sustained improvement in oxygenation in patients with acute respiratory distress syndrome who have a large shunt.
Crit Care Med, 30 (2002), pp. 1446-1452
[18.]
L. Gattinoni, G. Tognoni, A. Pesenti, P. Taccone, D. Mascheroni, V. Labarta, et al.
Effects of the prone positioning on the survival of patients with acute respiratory failure.
N Engl J Med, 345 (2001), pp. 568-573
[19.]
E. Messerole, P. Peine, S. Wittkopp, J.J. Marini, R.K. Albert.
The pragmatics of prone positioning.
Am J Respir Crit Care Med, 165 (2002), pp. 1359-1363
[20.]
A. Kornecki, H. Frndova, A.L. Coates, S.D. Shemie.
A randomized trial of prolonged prone positioning in children with acute respiratory failure.
Chest, 119 (2001), pp. 211-218
[21.]
N.S. Ward.
Effects of prone position ventilation in ARDS. An evidence-based review of the literature.
Crit Care Clin, 18 (2002), pp. 35-44
[22.]
M.A. Curley, J.E. Thompson, J.H. Arnold.
The effects of early and repeated prone positioning in pediatric patients with acute lung injury.
Chest, 118 (2000), pp. 156-163
[23.]
I. Frerking, A. Günther, W. Seeger, U. Pison.
Pulmonary surfactant: Functions, abnormalities and therapeutic options.
Int Care Med, 27 (2001), pp. 1699-1717
[24.]
D.A. Evans, R.W. Wilmott, J.A. Whistt.
Surfactant replacement therapy for adult respiratory distress syndrome in children.
[25.]
A. Anzueto, R.P. Baughman, K.K. Guntupalli, J.G. Weg, H.P. Wiedemann, A.A. Raventos, et al.
Aerolized surfactant in adults with sepsis-induced acute respiratory distress syndrome.
N Engl J Med, 334 (1996), pp. 1417-1421
[26.]
C.T. Nakamura, J.F. Ripka, K. McVeigh, N. Kapoor, T.G. Keens.
Bronchoscopic instillation of surfactant in acute respiratory distress syndrome.
Pediatr Pulmonol, 31 (2001), pp. 317-320
[27.]
T.P. Stevens, M. Blennow, R.F. Soll.
Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for RSD. (Cochrane review).
[28.]
C.C. Yost, R.F. Soll.
Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome.
[29.]
J.r. McIntyre RC, E.J. Pulido, D.D. Bensard, B.D. Shames, E. Abraham.
Thirty years of clinical trials in acute respiratory distress syndrome.
Crit Care Med, 28 (2000), pp. 3314-3331
[30.]
R.F. Soll, P. Dargaville.
Surfactante para el síndrome de aspiración de meconio en niños a término.
[31.]
D.F. Willson, A. Zaritsky, L.A. Bauman, K. Dockery, R.L. James, D. Conrad, et al.
Instillation of calf's lung surfactant extract (Infasurf) is beneficial in pediatric acute hypoxemic respiratory failure.
Crit Care Med, 27 (1999), pp. 188-195
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