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Boletín Médico del Hospital Infantil de México

2012, Número 6

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Bol Med Hosp Infant Mex 2012; 69 (6)


Papel actual de la presión positiva continua en la vía aérea en el síndrome de dificultad respiratoria y nuevas evidencias

Osorno CL

Idioma: Español
Referencias bibliográficas: 51
Paginas: 422-430
Archivo PDF: 216.88 Kb.


RESUMEN

La ventilación mecánica y el uso temprano o profiláctico de surfactantes han sido el estándar de manejo de neonatos con síndrome de dificultad respiratoria. La evidencia a favor de esta práctica está sustentada en meta-análisis de ensayos clínicos bien controlados. A finales de los 80, estudios observacionales mostraron que los centros que utilizaban la presión positiva continua en la vía aérea (CPAP) nasal como método primario de asistencia ventilatoria, tenían menor tasa de displasia broncopulmonar y asistían menos a la ventilación a sus neonatos. La falta de evidencias más sólidas ha sido una de las causas por las que este modo de atención haya permanecido restringido a pocos centros perinatales.
Se revisaron los ensayos clínicos de la última década que comparan el uso profiláctico o temprano de CPAP nasal vs la ventilación mecánica en neonatos de muy bajo peso, con el uso profiláctico o selectivo de surfactante, y la extubación pronta o programada. Las investigaciones recientes permiten afirmar que el CPAP nasal temprano es una alternativa a la intubación y surfactante, en prematuros extremos en sala de partos. Disminuye la necesidad de la ventilación mecánica, del uso de surfactante y esteroides para la displasia broncopulmonar. Un umbral bajo para surfactante en neonatos asistidos tempranamente con CPAP disminuye la necesidad de ventilación mecánica.


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