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UTILIZAÇAO DO OXIDO NITRICO INALADO EM CIRURGIA CARDIOTORACICA E NA INSUFICIENCIA CARDIACA. UMA REVISAO CRITICA DA LITERATURA

UTILIZAÇAO DO OXIDO NITRICO INALADO EM CIRURGIA CARDIOTORACICA E NA INSUFICIENCIA CARDIACA. UMA REVISAO CRITICA DA LITERATURA

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Na ausência de ensaios envolvendo grande número de pacientes, e, apesar de seu potencial tóxico, o NO inalado deve ser utilizado com extremo rigor técnico, como uma prova terapêutica que pode salvar vidas
evora9.jpg Autor:
Barbosa Evora, Paulo Roberto
Columnista Experto de SIIC

Institución:
Facultad de Medicina de Ribeirão Preto Universidad de São Paulo SP, Brasil


Artículos publicados por Barbosa Evora, Paulo Roberto
Coautores
Fernanda Viaro*  Alfredo J. Rodrigues**  Walter Vilella A. Vicente*** 
Mestre em Cirurgia (Cirurgia Experimental). Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo*
Professor Doutor. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo**
Professor Associado. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo***
Recepción del artículo
29 de Octubre, 2004
Aprobación
22 de Noviembre, 2004
Primera edición
31 de Marzo, 2005
Segunda edición, ampliada y corregida
14 de Febrero, 2006

Resumen
Objetivo: Apresentar uma revisão e análise crítica sobre a utilização do óxido nítrico (NO) pela via inalatória em cirurgia cardíaca. Método: metanálise de artigos publicados e inseridos no banco de dados Medline da National Library of Medicine dos Estados Unidos da América. Foram enfatizados aspectos da biologia do NO, mecanismos de ação seletiva do NO pela via inalatória, aspectos técnicos e éticos, aplicações clínicas em cirurgia cardíaca, além de uma análise crítica procurando demonstrar a atual posição da utilização do NO pela via inalatória. Resultado: As principais evidências foram: a) O NO inalado é reconhecido, atualmente, como um valioso recurso farmacológico da medicina intensiva neonatal e pediátrica, e para a cirurgia cardiopulmonar; b) Outras aplicações em adultos, como a doença pulmonar obstrutiva crônica e a síndrome da angústia respiratória do adulto, necessitam de cuidadosa observação; c) A terapêutica com o NO inalado é relativamente barata, mas não deve ser utilizada em todos os pacientes, com base nos paradigmas de sua eficiência e potencial toxicidade; d) As recentes descobertas de seus efeitos antiinflamatórios e extrapulmonares abrem novos horizontes para futuras aplicações. Conclusão: Embora seja evidente a extrema variabilidade da resposta vasodilatadora pulmonar seletiva do NO inalado, serviços que tratam pacientes portadores de distúrbios respiratórios, principalmente associados à hipertensão pulmonar, devem dispor do NO inalado como recurso terapêutico. Na ausência de ensaios envolvendo grande número de pacientes, e, apesar de seu potencial tóxico, o NO inalado deve ser utilizado com extremo rigor técnico, como uma prova terapêutica que pode salvar vidas.

Palabras clave
Óxido nítrico, uso terapêutico, hipertensão pulmonar, procedimentos cirúrgicos cardíacos


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Especialidades
Principal: 
Relacionadas: Bioquímica, Cirugía, Cuidados Intensivos, Farmacología, Medicina Interna, Neumonología



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Bibliografía del artículo
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