RESUMO
This article describes the incidence and etiology of anemia in critically ill children. In addition, the article details the pathophysiology and clinical ramifications of anemia in this population. The use of transfused packed red blood cells as a therapy for anemia in critically ill patients is also discussed, including the indications for and complications associated with this practice as well as potential reasons for these complications. Finally, the article lists some therapeutic practices that may lessen the risks associated with transfusion, and briefly discusses the use of blood substitutes.
Assuntos
Lesão Pulmonar Aguda/etiologia , Anemia/terapia , Transfusão de Sangue/normas , Eritropoetina/uso terapêutico , Imunomodulação , Ferro/uso terapêutico , Anemia/complicações , Anemia/etiologia , Substitutos Sanguíneos/uso terapêutico , Transfusão de Sangue/métodos , Criança , Pré-Escolar , Estado Terminal/terapia , Eritropoetina/deficiência , Eritropoetina/fisiologia , Hemodiluição/efeitos adversos , Hemodiluição/normas , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Flebotomia/efeitos adversos , Fatores de Risco , Reação Transfusional , Resultado do TratamentoAssuntos
Mortalidade Hospitalar , Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Fatores Etários , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/mortalidade , Criança , Pré-Escolar , Cuidados Críticos/métodos , Estado Terminal/mortalidade , Estado Terminal/terapia , Feminino , Seguimentos , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Humanos , Hipotermia Induzida/mortalidade , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Masculino , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/terapia , Valores de Referência , Medição de Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
Cysteinyl leukotrienes are increased during acute lung injury in animals and humans. In this study, we determined the effect of leukotriene D4 (LTD4) on the function of Na,K-ATPase in alveolar epithelial cells and on alveolar fluid clearance in rat lungs. LTD4 (1 x 10(-7) M) increased Na,K-ATPase activity at 1 and 5 minutes by 14% (p < 0.05) and 31% (p < 0.001), respectively, in A549 alveolar epithelial cells. This was accompanied by recruitment of Na,K-ATPase alpha1 subunits from intracellular compartment(s) to the basolateral plasma membrane. LTD4-induced alpha1 Na,K-ATPase membrane translocation was blocked by the dual cysteinyl LT1 (cysLT1)/ cysteinyl LT3 (cysLT3) receptor antagonist BAY-u9773, but not by the cysLT1 antagonist MK571, implicating the cysLT3 receptor. Expression of mRNA for cysLT2, but not cysLT1, was confirmed in A549 cells and rat alveolar type 2 cells by reverse transcriptase-polymerase chain reaction. Finally, compared with control, LTD4 (1 x 10(-11) M) increased alveolar fluid clearance by 41% (p < 0.001) in isolated, perfused rat lungs; this was also blocked by BAY-u9773 but not MK571. By activating alveolar epithelial Na,K-ATPase and increasing alveolar fluid reabsorption, cysteinyl leukotrienes may, in part, have a beneficial role in the acute respiratory distress syndrome.
