ABSTRACT
El iloprost inhalado es uno de los fármacos más recientes del grupo de prostanoides en el tratamiento de la hipertensión arterial pulmonar. No se ha definido su importancia en la hipertensión pulmonar en el perioperatorio de cirugía cardiovascular. En esta revisión se analizan los grupos con hipertensión pulmonar susceptibles de cirugía cardiaca, la importancia de la hipertensión pulmonar en cirugía cardiaca y, además, la evidencia clínica actual del uso del fármaco en este contexto.
Inhaled iloprost is one of the most recent drugs from prostanoids group's in the treatment of pulmonary arterial hypertension. His place in pulmonary hypertension seen in the perioperative cardiovascular surgery has not been defined. In this review we analyze pulmonary hypertension group's susceptibles of cardiac surgery and its importance, besides the current clinical evidence from drug use in this context.
Subject(s)
Humans , Hypertension, Pulmonary/drug therapy , Iloprost/administration & dosage , Postoperative Complications/drug therapy , Vasodilator Agents/administration & dosage , Administration, Inhalation , Cardiac Surgical ProceduresABSTRACT
El iloprost inhalado es un fármaco del grupo de las prostaciclinas utilizado en el tratamiento de la hipertensión arterial pulmonar. La eficacia y seguridad de su administración han permitido su uso como monoterapia y en terapia combinada. En esta revisión se describen las características del medicamento, los grupos susceptibles de tratamiento y la evidencia clínica actualizada del uso del fármaco.
Inhaled iloprost is a drug from the group of prostacyclins used in the treatment of pulmonary arterial hypertension. Its efficacy and safety have allowed its use as monotherapy and combination therapy. This review describes the product characteristics, amenable to treatment groups, and updated clinical evidence of drug use.
Subject(s)
Humans , Hypertension, Pulmonary/drug therapy , Iloprost/administration & dosage , Vasodilator Agents/administration & dosage , Administration, Inhalation , Drug Therapy, CombinationABSTRACT
OBJETIVOS: Embora reconhecida há décadas, ainda pouco se sabe a respeito da etiologia, fisiopatologia e prevenção da hipertensão pulmonar persistente neonatal (HPPN), e seu tratamento continua a ser um grande desafio para os neonatologistas. Nesta revisão, vamos abordar as características clínicas e os mecanismos fisiopatológicos da síndrome, assim como seu tratamento geral e específico. FONTES DE DADOS: Fizemos uma revisão nas bases de dados PubMed, Cochrane Library e MRei Consult , procurando por artigos relacionados à síndrome e publicados entre 1995 e 2011. SÍNTESE DE DADOS: São discutidos os fatores de risco e os mecanismos fisiopatológicos da síndrome. O quadro clínico depende dos diferentes fatores envolvidos, que provavelmente estão relacionados com a etiologia e o mecanismo fisiopatológico. Além das medidas utilizadas para permitir a queda da resistência vascular pulmonar após o nascimento, alguns casos necessitam de vasodilatadores pulmonares. Embora o óxido nítrico tenha se provado efetivo, recentemente, outros vasodilatadores têm sido usados, mas ainda faltam evidências clínicas para comprovar seus benefícios no tratamento da HPPN. CONCLUSÕES: Apesar dos recentes avanços tecnológicos e dos novos conhecimentos fisiopatológicos, a mortalidade associada à HPPN ainda é de 10%. São necessárias mais pesquisas clínicas e resultados experimentais baseados em evidências para prevenir, tratar e reduzir a morbimortalidade associada a esta síndrome neonatal.
OBJECTIVES: Although recognized for decades, little is known about the etiology, physiopathology, and prevention of persistent pulmonary hypertension of the newborn (PPHN). and its treatment remains a major challenge for neonatologists. In this review, the clinical features and physiopathology of the syndrome will be addressed, as well as its general and specific treatments. DATA SOURCE: A review was carried out in PubMed, Cochrane Library, and MRei consult databases, searching for articles related to the syndrome and published between 1995 and 2011. DATA SYNTHESIS: Risk factors and the physiopathological mechanisms of the syndrome are discussed. The clinical picture depends on the different factors involved, which are probably related to the etiology and physiopathological mechanisms. In addition to the measures used to allow the decrease in pulmonary vascular resistance after birth, some cases will require pulmonary vasodilators. Although nitric oxide has proved effective, other vasodilators have been recently used, but clinical evidence is still lacking to demonstrate their benefits in the treatment of PPHN. CONCLUSIONS: Despite recent technological advances and new physiopathological knowledge, mortality associated with PPHN remains at 10%. More clinical research and evidence-based experimental results are needed to prevent, treat, and reduce the morbidity/mortality associated with this neonatal syndrome.