Evaluación hemodinámica y respuesta al óxido nítrico inhalado ante hipoxia y acidosis en cerdos recién nacidos

Hemodynamic evaluation and response to inhaled nitric oxyde in newborn piglets Pulmonary hypertension (HTP) is a frequently pathological situation of maladaptation to the extratuerine life in newborns. Hypoxia and acidosis are key factors capable of evoking the referred situation and can also act as a perpetuator factor of it. Objectives: To evaluate the effect of inhaled nitric oxide (iNO) on pulmonary vascular response to hypoxia and acidosis in newborn pigs. Material and Methods: we performed a series of experimental interventions in newborn pigs, sedated, anesthetized and mechanical ventilation. The experimen- tal protocol was to induce hypoxia in a controlled and progressive (FiO2 from 0.21 (baseline) to 0.14, 0.10 or 0.08, mixing nitrogen with air), between 6 and 10 minutes, evaluating the hemodynamic response. Stabilized response to hypoxia plateau elevation in pulmonary artery pressure (PAP) and systemic administered iNO at 20 ppm. By infusion of HCl 0.1 N i/v was stable at different pH values which were reiterated in this series of experiments. Results: we found that the decrease in FiO2 (below 0,21) produces a fall in saturation and an immediate increase in PAP at different pH and an ERA of iNO for the PAP down near 70%. However, at lower pH, the presence of acidosis produces a basal level of PAP high relative to pH 7.4, which does not descend iNO. As PH developed at different FiO2 was confi rmed that the elevation of the PAP is gradually higher. Con- clusion: experimental research in newborn pigs shows that the short-term hypoxic events generate HTP and instability on systemic hemodynamics. Similarly acidosis induces an increase in baseline PAP in this experi- mental model. Under these conditions the application of iNO decreases the PAP effectively without altering systemic hemodynamics. Its action is more effective at normal pH than in acidosis. (Key words: Hemodynamics, nitric oxide, anoxia, acidosis, hypertension pulmonary, animals newborn). Arch Pediatr Urug 2009; 80 (4): 262-268