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El gas de nitrito de etilo inhalado para la hipertensión pulmonar persistente del recién nacido
Martin P Moya1, Andrew J Gow, Robert M Califf
1Neonatal-Perinatal Research Institute, Department of Pediatrics, Duke University Medical Center, Durham NC 27710, USA.
Lancet (London, England)
|July 20, 2002
Resumen
La inhalación de gas O-nitrosoetanol (ENO) ofrece una alternativa más segura para el tratamiento de la hipertensión pulmonar persistente en recién nacidos. Mejora la oxigenación y la hemodinámica al tiempo que reduce los subproductos tóxicos asociados con la terapia con óxido nítrico.
Área de la Ciencia:
- Medicina Neonatal La medicina neonatal es una especialidad de la medicina neonatal.
- Medicina Pulmonar La medicina pulmonar es el tratamiento de las enfermedades pulmonares.
- Farmacología Farmacología.
Sus antecedentes:
- El óxido nítrico inhalado (iNO) trata la hipertensión pulmonar y la hipoxemia, pero causa subproductos tóxicos.
- Estos subproductos, incluidos los óxidos de nitrógeno (NOx), pueden conducir a hipoxia de rebote y aumento de la morbilidad.
- Se necesita una alternativa más segura a iNO para el soporte respiratorio neonatal.
Objetivo del estudio:
- Evaluar el gas O-nitrosoetanol inhalado (ENO) como una nueva alternativa para la bioactividad del óxido nítrico.
- Evaluar la eficacia de ENO en el tratamiento de la hipertensión pulmonar persistente en recién nacidos (PPHN).
- Para determinar si ENO reduce los subproductos tóxicos y la hipoxia de rebote.
Principales métodos:
- Siete recién nacidos con NPPH que requieren ventilación asistida recibieron ENO inhalado durante 4 horas.
- Se monitoreó el índice de oxigenación (OI), con un OI basal ≥ 25.
- ENO se interrumpió durante 15 minutos antes de iniciar el tratamiento con iNO.
Principales resultados:
- La administración de ENO condujo a mejoras sostenidas en la oxigenación arterial postductal.
- La hemodinámica sistémica mostró mejoras sostenidas durante el período de ausencia de drogas.
- Se observaron aumentos modestos en la metahemoglobinemia; no se detectaron subproductos tóxicos de NOx.
Conclusiones:
- El gas O-nitrosoetanol (ENO) inhalado mejora efectivamente la oxigenación y la hemodinámica sistémica en los neonatos.
- ENO parece mitigar la hipoxia de rebote y reducir la producción de subproductos tóxicos.
- ENO presenta una alternativa prometedora al óxido nítrico inhalado para el tratamiento de PPHN.
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