Papel del óxido nítrico (NO) endógeno en la adaptación del lecho vascular pulmonar a la ventilación unilateral durante intervenciones torácicas

Varela, G.; Jiménez, M.

doi:10.1016/S0300-2896(15)30452-X

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

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Medline, Science Citation Index Expanded (SCIE)

Pertenecían al grupo experimental 19 pacientes sometidos a intervenciones torácicas con VPS y monitorización mediante catéter de Swan-Ganz. Se midieron parámetros hemodinámicos y se extrajeron muestras de sangre venosa periférica al empezar el acto quirúrgico y 10 minutos después de comenzar la ventilación pulmonar selectiva. El grupo control lo forman 13 pacientes de características clínicas comparables, sometidos a intervenciones torácicas con ventilación pulmonar convencional. Se extrajeron muestras de sangre venosa periférica al comenzar el acto quirúrgico y en un período de tiempo equivalente al grupo control. Determinación de NO: por técnica colorimétrica cuantitativa como concentración de nitritos en las muestras de sangre venosa extraídas.

En el grupo experimental, la concentración de nitritos es mayor durante la VPS (12,7±10,1 μmol/ml) que antes de comenzarla (7,1±5,4 μmol/ml, p<0,05); en el grupo control los valores son similares en ambos tiempos (8,7±2,8 μMol/ml al comenzar la cirugía y 8,1±3,2 μMol/ml en la segunda medición). La media de incremento porcentual de concentración de nitritos en el grupo experimental es de 93,7±117% y en el grupo control -3,9±23% (p<0,001). En el grupo experimental la media de las RVP durante la VPS (134±45 din⋅s⋅cm-5) es menor que al comienzo de la cirugía (163±37 din⋅s⋅cm-5, p<0,05).

Durante la VPS se produce un incremento de la producción endógena de NO (medida como concentración plasmática de nitritos) y una disminución de las RVP que podría estar en relación con el hallazgo anterior.

Palabras clave:

Ventilación pulmonar selectiva

Óxido nítrico

Resección pulmonar

Fisiopatología

To determine whether endogenous production of nitric oxide (NO) increases during one-lung lung ventilation (OLV) and to observe its possible influence on pulmonary vascular resistance (PVR).

The experimental group consisted of 19 patients under-going chest surgery with OLV, with monitoring by Swan-Ganz catheter. Hemodynamic parameters were measured and peripheral venous blood samples were taken at the start of surgery and 10 minutes after starting OLV. The control group consisted of 13 patients with comparable clinical characteristics undergoing chest surgery with conventional lung ventilation. In this group samples of peripheral venous blood were taken at the start of surgery and at a moment comparable to the sampling of the experimental group. NO was assessed by quantitative colorimetry as the concentration of nitrites in venous blood.

Nitrite concentration in the experimental group was higher during OLV (12.7±10.1 μMol/ml) than initially (7.1±5.4 μMol/ml) (p<0.05). Nitrite concentration was similar at the two moments sampled in the control group (8.7±2.8 μMol/ml at the start of surgery and 8.1±3.2 μMol/ml in the second sample taken). Mean percent increase in nitrite concentration in the experimental group was 93.7±117%; mean percent change in the control group was 3.9 ±23% (p<0.001). PVR during OLV (134±45 din⋅s⋅cm-5) is lower than at the start of surgery (163±37 din⋅s⋅cm-5, p<0.05).

During OLV endogenous production of NO, measured as nitrite concentration in plasma, increases. PVR decreases, possibly because of the increase in nitrite concentration.

Key words:

One-lung ventilation

Nitric oxide

Lung resection

Pathophysiology

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