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ISSN 0035-0052 (Impreso)

2006, Número 5

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Rev Mex Pediatr 2006; 73 (5)


El óxido nítrico inhalado en recién nacidos con hipoxia

Rodríguez BI, Cárdenas CBG

Idioma: Español
Referencias bibliográficas: 47
Paginas: 245-252
Archivo PDF: 79.11 Kb.


RESUMEN

El óxido nítrico (ON) es un gas con vasodilatador, selectivo al sistema pulmonar, por lo que mejora el proceso ventilación/perfusión. Es útil en los neonatos, en su primera semana de vida y con 34 semanas o más de gestación, que tienen insuficiencia respiratoria hipoxémica que precise de ventilación mecánica y con evidencia ecocardiográfica de hipertensión pulmonar persistente (HPP); en estos niños se sugiere iniciar su manejo con ON a 20 ppm, si son neonatos de término o cerca de término, y a una dosis de 5 ppm en las siguientes 4 a 24 h. La duración del tratamiento usualmente es por cinco días. También se recomienda descontinuar el ON cuando el FIO2 sea ‹ 60% y la PaO2 sea › 60 mmHg. Exposición prolongada a altas dosis de ON mayor de 40 ppm puede causar metahemoglobinemia y aumento del dióxido de nitrógeno. El reclutamiento pulmonar es vital para la eficacia del ON en presencia de HPP y severa enfermedad pulmonar, esto se logra usando la ventilación de alta frecuencia oscilatoria (VAFO). El uso de ON en niños con hernia diafragmática congénita no ha mostrado que evite la oxigenación favorecida por el empleo de membrana extracorpórea (ECMO) pero permite estabilizar a los niños que necesitarán ECMO; también se recomienda cuando egresan de la ECMO y tienen hipertensión pulmonar tardía.


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