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Vol. 58. Núm. 2.
Páginas 106-114 (febrero 2003)
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Vol. 58. Núm. 2.
Páginas 106-114 (febrero 2003)
Acceso a texto completo
Efecto del óxido nítrico, la postura en prono y la administración de surfactante en niños con enfermedad pulmonar hipoxémica
Effects of prone position, inhaled nitric oxide and surfactant in children with hypoxemic pulmonary disease
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9045
J. López-Herce Cid
Autor para correspondencia
pielvi@eresmas.net

Correspondencia: Arzobispo Morcillo, 52, 9.º C. 28029 Madrid. España
, E. García Sánchez, C. García Sanz, M. Rupérez Lucas, A. Alcaraz Romero, A. Carrillo Álvarez
Sección de Cuidados Intensivos Pediátricos. Hospital General Universitario Gregorio Marañón. Madrid. España
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Estadísticas
objetivo

Analizar la respuesta al tratamiento con la postura enprono, el óxido nítrico (NO) y la administración de surfactante en niños con enfermedad pulmonar hipoxémica.

Pacientes y método

Se realizó un análisis del efecto de la postura en prono,el NO y el surfactante en niños críticamente enfermos con enfermedad pulmonar e hipoxemia refractaria al tratamiento convencional. Se estudiaron la presión arterial deoxígeno (PaO2), saturación de hemoglobina, relación PaO2/FiO2, índice de oxigenación (IO), y presión parcialarterial de anhídrico carbónico (PaCO2), antes y tras la administraciónde cada uno de los tratamientos, así como laevolución clínica posterior. Se consideró una respuestapositiva cuando la relación PaO2/FiO2 aumentó másdel 20%

Resultados

Se estudiaron 90 tratamientos en 56 pacientes: 55 pacientes recibieron NO, 18 postura en prono y 17 surfactante.Los 3 tratamientos produjeron una mejoría significativa en la oxigenación. La relación PaO2/FiO2 experimentóun incremento medio del 35 % con el NO, el33 % con el prono, y el 50 % con el surfactante. El descensomedio del IO fue del 22 % con el NO, el 24 % con el prono,y el 17 % con el surfactante. Se consideraron respondedoresel 71 % de los tratados con NO, el 61 % de lostratados con prono y el 64 % de los que recibieron surfactante.La PaCO2 disminuyó ligeramente con los 3 tratamientos (disminución media, 2,5 mmHg con el NO;4,7 mmHg con el prono, y 5,1 mmHg con el surfactante)

Conclusiones

La posición en prono, el NO y el surfactante mejoran laoxigenación en algunos niños con enfermedad pulmonar hipoxémica

Palabras clave:
Óxido nítrico
Surfactante
Postura en prono
Síndromede dificultad respiratoria aguda
Cuidados intensivos
Niños críticamente enfermos
objective

To analyze the therapeutic response to prone position,inhaled nitric oxide (NO) and surfactant in children with hypoxemic pulmonary disease.

Patients and method

We studied the effect of prone position, NO, and surfactantin critically ill children with acute hypoxemic pulmonary disease unresponsive to conventional therapy. We analyzed PaO2, SatO2, the PaO2/FiO2 ratio, oxygenation index and PaCO2 before and after each treatment, as well as the subsequent clinical course. An increase of more than 20 % in the PaO2/FiO2 ratio was considered a positive response

Results

Ninety treatments were administered in 56 patients:55 patients were treated with NO, 18 with prone positionand 17 with surfactant. All three treatments substantially improved oxygenation. The mean increase in the PaO2/FiO2 ratio was 35 % with nitric oxide, 33 % with prone position and 50 % with surfactant. The mean decrease in oxygenation index was 22 % with nitric oxide, 24 % with prone position and 17% with surfactant. Seventy-one percent of patients treated with NO, 61 % of patients treated with prone position, and 64 % of patients who received surfactant were responders. The three treatments produced a slight decrease in PaCO2 (2.5 mmHg with nitric oxide, 4.7 mmHg with prone position and 5.1 mmHg with surfactant).

Conclusions

Inhaled NO, prone position and surfactant improve oxygenationin some children with hypoxic pulmonary disease

Key words:
Prone position
Nitric oxide
Surfactant
Acute respiratorydistress syndrome
Intensive care
Critically ill children
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