Óxido nítrico inhalado en pacientes adultos con síndrome de distrés respiratorio agudo

José Ángel Monsalve-Naharro; Esther Domingo-Chiva; Sergio García Castillo; Pablo Cuesta-Montero; José María Jiménez-Vizuete

doi:10.7399/fh.2017.41.2.10533

Óxido nítrico inhalado en pacientes adultos con síndrome de distrés respiratorio agudo

José Ángel Monsalve-Naharro, Esther Domingo-Chiva, Sergio García Castillo, Pablo Cuesta-Montero, José María Jiménez-Vizuete

Resumen

En algunos pacientes, el síndrome de distrés respiratorio agudo (SDRA) provoca el desarrollo de una hipoxemia refractaria que compromete la vida. En este contexto pueden considerarse terapias de rescate en un intento de mejorar la oxigenación mientras los pacientes permanecen en ventilación mecánica. El uso de óxido nítrico inhalado (NOi) en el SDRA ha sido una de las terapias farmacológicas más estudiadas en las últimas dos décadas. Diversos ensayos clínicos y metaanálisis han evaluado su eficacia, y aunque se ha demostrado un aumento en la oxigenación, no se ha podido demostrar un descenso en la mortalidad o una mejora en el pronóstico. La evidencia actual sugiere que aunque el NOi no debe usarse de forma rutinaria en pacientes con SDRA, puede considerarse su uso para mejorar la oxigenación en pacientes severamente hipoxémicos.
Esta revisión examina la aplicación terapéutica del NOi en pacientes adultos con SDRA. Se propone un esquema con diversas recomendaciones para su uso como terapia de rescate frente a la hipoxemia refractaria.

Palabras clave

Síndrome de distrés respiratorio agudo; Lesión pulmonar aguda; Hipoxemia; Óxido nítrico

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Referencias

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DOI: http://dx.doi.org/10.7399%2Ffh.2017.41.2.10533