RESUMEN
Although the most important primary local inflammatory response factor to intubation is not yet clear, it is known that it may be directly attributed to the presence of trauma during intubation or the response of oral bacterial flora present in the trachea. It is known that prolonged intubation is associated with worse outcomes, but other underlying systemic issues, such as sepsis and trauma, are also associated with this result. Likewise, patients who require advanced airway management and excessive manipulation are more likely to experience complications. There are various inflammatory mediators that are generated during orotracheal intubation, many of which can be considered targets for therapies to help reduce inflammation caused by intubation. However, there is little evidence on the management of the inflammatory response induced by orotracheal intubation in pediatric patients. Therefore, the aim of this narrative review is to highlight the intubation associated complications that can arise from poorly controlled inflammation in intubated pediatric patients, review the proposed pathophysiology behind this, and discuss the current treatments that exist. Finally, taking into account the discussion on pathophysiology, we describe the current therapies being developed and future directions that can be taken in order to create more treatment options within this patient population.
Asunto(s)
Intubación Intratraqueal , Tráquea , Humanos , Niño , Estudios Retrospectivos , Intubación Intratraqueal/efectos adversos , InflamaciónRESUMEN
The tightly coupled, one-for-one exchange of anions mediated by the human red blood cell AE1 anion-exchange protein involves a ping-pong mechanism, in which AE1 alternates between a state with the anion-binding site facing inward toward the cytoplasm (Ei) and a state with the site facing outward toward the external medium (Eo). The conformational shift (Ei <--> Eo) is only permitted when a suitable substrate such as Cl(-) or HCO(3)(-) (B(-)) is bound. With no anions bound, or with Cl(-) bound, far more AE1 molecules are in the inward-facing than the outward-facing forms (Ei Eo, ECli EClo). We have constructed a model for CI(-)-B(-) exchange based on Cl(-)-Cl(-) and B(-)-B(-) exchange data, and have used it to predict the heteroexchange flux under extremely asymmetric conditions, with either all Cl(-) inside and all B(-) outside (Cli-Bo) or vice versa (Bi-Clo). The experimental values of the ratio of the exchange rate for Bi-Clo to that for Cli-Bo are only compatible with the model if the asymmetry of bicarbonate-loaded sites (A(B) = EBo/EBi) > 10, the opposite of the asymmetry for unloaded or Cl-loaded sites. Furthermore, the Eo form has a higher affinity for HCO(3)(-) than for Cl(-), whereas the Ei form has a higher affinity for Cl(-). The fact that this "passive" system exhibits changes in substrate selectivity with site orientation ("sidedness"), a characteristic usually associated with energy-coupled "active" pumps, suggests that changes in affinity with changes in sidedness are a more general property of transport proteins than previously thought.