Consideraciones sobre reanimaci\uf3n neonatal

En la actualidad, existen dos \ue1reas mayores en la reanimaci\uf3n del reci\ue9n nacido que han originado dudas: el uso de ventilaci\uf3n con presi\uf3n positiva inienratente y lar administrac\ufc>n de ox\uedgeno. Cada vez surgen m\ue1s pruebas que indican que el volutrau ma relacionado con la IPPV, en especial en prematuros, suele inducir cambios en los pulmones que pueden dar lugar a una enfermedad pulmonar cr\uf3nica. Existen razones para pensar que el uso de presi\uf3n positiva continua en las v\uedas respiratorias de prematuros que est\ue1n llevando a cabo esfuerzos respiratorios, puede ver menos perjudicial que el empleo de ventilaci\uf3n con presi\uf3n positiva intermitente (IPPV). Con respecto al uso de ox\uedgeno, es claro que la mayor\ueda de los lactantes pueden reanimarse con \ue9xito con aire ambiente. Aunque es posible identificar marcadores de estr\ue9s oxidativo en reci\ue9n nacidos que se reanimara con ox\uedgeno al 100%, a\ufan es un tema abierto la importancia cl\uednica de estos marcadores. Si se demuestra que la presencia de estos marcadores despu\ue9s de la reanimaci\uf3n .se relaciona con problemas cl\uednicos, entonces quiz\ue1 sea necesario considerar el empleo de ox\uedgeno

Neutrophil extracellular traps contribute to immunothrombosis in COVID-19 acute respiratory distress syndrome.

COVID-19 affects millions of patients worldwide, with clinical presentation ranging from isolated thrombosis to acute respiratory distress syndrome (ARDS) requiring ventilator support. Neutrophil extracellular traps (NETs) originate from decondensed chromatin released to immobilize pathogens, and they can trigger immunothrombosis. We studied the connection between NETs and COVID-19 severity and progression. We conducted a prospective cohort study of COVID-19 patients (n = 33) and age- and sex-matched controls (n = 17). We measured plasma myeloperoxidase (MPO)-DNA complexes (NETs), platelet factor 4, RANTES, and selected cytokines. Three COVID-19 lung autopsies were examined for NETs and platelet involvement. We assessed NET formation ex vivo in COVID-19 neutrophils and in healthy neutrophils incubated with COVID-19 plasma. We also tested the ability of neonatal NET-inhibitory factor (nNIF) to block NET formation induced by COVID-19 plasma. Plasma MPO-DNA complexes increased in COVID-19, with intubation (P < .0001) and death (P < .0005) as outcome. Illness severity correlated directly with plasma MPO-DNA complexes (P = .0360), whereas Pao2/fraction of inspired oxygen correlated inversely (P = .0340). Soluble and cellular factors triggering NETs were significantly increased in COVID-19, and pulmonary autopsies confirmed NET-containing microthrombi with neutrophil-platelet infiltration. Finally, COVID-19 neutrophils ex vivo displayed excessive NETs at baseline, and COVID-19 plasma triggered NET formation, which was blocked by nNIF. Thus, NETs triggering immunothrombosis may, in part, explain the prothrombotic clinical presentations in COVID-19, and NETs may represent targets for therapeutic intervention.status: publishe