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Óxido nítrico inhalado en la hipertensión pulmonar persistente del recién nacido
J D Roberts1, D M Polaner, P Lang
1Department of Anesthesia, Massachusetts General Hospital, Boston 02114.
Lancet (London, England)
|October 3, 1992
Resumen
El óxido nítrico (NO) inhalado mejoró rápidamente la oxigenación en bebés con hipertensión pulmonar persistente del recién nacido (PPHN). Este tratamiento fue seguro, no mostrando efectos adversos sobre la presión arterial o los niveles de metahemoglobina.
Área de la Ciencia:
- Medicina Neonatal La medicina neonatal es una especialidad de la medicina neonatal.
- Cardiología Pediátrica Cardiología pediátrica.
- Fisiología de las vías respiratorias.
Sus antecedentes:
- La hipertensión pulmonar persistente del recién nacido (HPPN) es una condición crítica caracterizada por una elevada resistencia vascular pulmonar.
- El óxido nítrico (NO) es un vasodilatador pulmonar conocido en adultos y animales, pero sus efectos en neonatos con PPHN requieren más investigación.
- La hipoxemia es una complicación importante de PPHN, que requiere intervenciones terapéuticas efectivas.
Objetivo del estudio:
- Evaluar la eficacia y seguridad del óxido nítrico (NO) inhalado en la mejora de la oxigenación sistémica en lactantes con PPHN.
- Evaluar el impacto del NO inhalado en la presión arterial sistémica y los niveles de metahemoglobina en esta población de pacientes.
Principales métodos:
- Seis bebés con diagnóstico de PPHN recibieron NO inhalado en concentraciones de hasta 80 partes por millón en volumen (ppmv) con una fracción de oxígeno inspirado (FiO2) de 0,9 durante hasta 30 minutos.
- La oxigenación sistémica fue monitoreada por oximetría de pulso preductal y postductal (SpO2) y tensiones de oxígeno arterial.
- La presión arterial sistémica y los niveles de metahemoglobina fueron monitoreados de cerca para evaluar la seguridad.
Principales resultados:
- La administración inhalada de NO dio lugar a un aumento rápido y significativo de la SpO2 preductal en todos los lactantes tratados.
- Cinco de cada seis bebés demostraron mejoras en las tensiones postductales de SpO2 y oxígeno, lo que indica una mayor oxigenación sistémica.
- No se observaron casos de hipotensión sistémica o niveles elevados de metahemoglobina durante el período de tratamiento, lo que sugiere un perfil de seguridad favorable.
Conclusiones:
- El bajo nivel de óxido nítrico inhalado (NO) es una estrategia terapéutica efectiva para revertir la hipoxemia en bebés que sufren de PPHN.
- El NO inhalado demuestra un perfil de seguridad prometedor en neonatos con PPHN, sin efectos hemodinámicos o hematológicos adversos significativos.
- Estos hallazgos apoyan el uso de NO inhalado como una herramienta valiosa en el manejo de PPHN, mejorando la oxigenación y los resultados clínicos potencialmente.
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