Point of view
Nitric oxide as the third respiratory gas. A new opportunity to revisit the use of oxygen therapy in clinical practice
Óxido nítrico como tercer gas respiratorio. Una nueva ocasión para revisar el empleo de oxigenoterapia en la práctica clínica
José Manuel Valencia-Gallardoa,
, Felipe Rodríguez de Castrob, Jordi Solé-Violánc, José Carlos Rodríguez-Gallegod
Autor para correspondencia
a Department of Respiratory Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
b Professor of Medicine, Department of Medical and Surgical Sciences, School of Medicine, University of Las Palmas de Gran Canaria, Spain
c Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
d Department of Immunology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
Leído
83
Vecesse ha leído el artículo
23
Total PDF
60
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S0210569124002341" "issn" => "02105691" "doi" => "10.1016/j.medin.2024.06.006" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "2062" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2024;48:543-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S217357272400170X" "issn" => "21735727" "doi" => "10.1016/j.medine.2024.06.016" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "2062" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2024;48:543-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>" "titulo" => "Nitric oxide as the third respiratory gas. A new opportunity to revisit the use of oxygen therapy in clinical practice" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "543" "paginaFinal" => "545" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Óxido nítrico como tercer gas respiratorio. Una nueva ocasión para revisar el empleo de oxigenoterapia en la práctica clínica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1346 "Ancho" => 2508 "Tamanyo" => 287674 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Allosteric linkage of Hb conformation to O<span class="elsevierStyleInf">2</span> and SNO release. Left (Hb in red): cooperativity leads to Hb in the lung being able to bind oxygen molecules. Oxygenated Hb will also bind and stabilize SNO at Hb. Right (Hb in blue): upon reaching hypoxic tissues, Hb will cooperatively release oxygen molecules during transition to the deoxygenated state. Liberation of oxygen also causes the transfer of SNO from deoxygenated Hb to other erythrocyte thiols (R-S-H) and ultimately shuttling SNO out of red blood cells. Thus, Hb deoxygenation in tissues will lead to vasorelaxation (SNO-mediated vasodilation). Adapted from reference 6, with permission.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Manuel Valencia-Gallardo, Felipe Rodríguez de Castro, Jordi Solé-Violán, José Carlos Rodríguez-Gallego" "autores" => array:4 [ 0 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Valencia-Gallardo" ] 1 => array:2 [ "nombre" => "Felipe" "apellidos" => "Rodríguez de Castro" ] 2 => array:2 [ "nombre" => "Jordi" "apellidos" => "Solé-Violán" ] 3 => array:2 [ "nombre" => "José" "apellidos" => "Carlos Rodríguez-Gallego" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0210569124002341" "doi" => "10.1016/j.medin.2024.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569124002341?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357272400170X?idApp=WMIE" "url" => "/21735727/0000004800000009/v1_202409021221/S217357272400170X/v1_202409021221/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0210569124001438" "issn" => "02105691" "doi" => "10.1016/j.medin.2024.04.006" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "2027" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2024;48:546-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICA</span>" "titulo" => "Síndrome de distrés respiratorio agudo en la altitud: consideraciones sobre el diagnóstico y tratamiento" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "546" "paginaFinal" => "548" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acute respiratory distress syndrome at high altitude: considerations for diagnosis and treatment" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Adrián Avila-Hilari, Amílcar Tinoco-Solórzano, Jorge Vélez-Páez, Daniel Molano Franco, Felipe de Jesús Montelongo, Manuel Luis Avellanas-Chavala" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Adrián" "apellidos" => "Avila-Hilari" ] 1 => array:2 [ "nombre" => "Amílcar" "apellidos" => "Tinoco-Solórzano" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Vélez-Páez" ] 3 => array:2 [ "nombre" => "Daniel" "apellidos" => "Molano Franco" ] 4 => array:2 [ "nombre" => "Felipe" "apellidos" => "de Jesús Montelongo" ] 5 => array:2 [ "nombre" => "Manuel Luis" "apellidos" => "Avellanas-Chavala" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572724001978" "doi" => "10.1016/j.medine.2024.04.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724001978?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569124001438?idApp=WMIE" "url" => "/02105691/0000004800000009/v1_202408290622/S0210569124001438/v1_202408290622/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0210569124002110" "issn" => "02105691" "doi" => "10.1016/j.medin.2024.05.008" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "2041" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2024;48:528-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Puesta al día en medicina intensiva: ecografía en el paciente crítico. Aplicaciones clínicas</span>" "titulo" => "Disfunción del ventrículo derecho en el paciente crítico. Evaluación ecocardiográfica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "528" "paginaFinal" => "542" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Right ventricular dysfunction in the critically ill. Echocardiographic evaluation" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figura 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1735 "Ancho" => 2334 "Tamanyo" => 279301 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Algoritmo para determinar la probabilidad de presentar hipertensión pulmonar mediante ecocardiografía. <span class="elsevierStyleSup">a</span> Necesaria la presencia de signos de al menos 2 categorías. <span class="elsevierStyleSup">b</span> Colapso <<span class="elsevierStyleHsp" style=""></span>50% con la inspiración forzada, <<span class="elsevierStyleHsp" style=""></span>20% con inspiración normal. AD: aurícula derecha; AP: arteria pulmonar; HP: hipertensión pulmonar; PAPs: presión sistólica de la arteria pulmonar; TAPSE: excursión sistólica del plano del anillo tricuspídeo; TSVD: Tracto de salida del ventrículo derecho; VCI: vena cava inferior; VD: ventrículo derecho; VI: ventrículo izquierdo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Virginia Fraile Gutiérrez, Luis Zapata Fenor, Aaron Blandino Ortiz, Manuel Guerrero Mier, Ana Ochagavia Calvo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Virginia" "apellidos" => "Fraile Gutiérrez" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Zapata Fenor" ] 2 => array:2 [ "nombre" => "Aaron" "apellidos" => "Blandino Ortiz" ] 3 => array:2 [ "nombre" => "Manuel" "apellidos" => "Guerrero Mier" ] 4 => array:2 [ "nombre" => "Ana" "apellidos" => "Ochagavia Calvo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572724001735" "doi" => "10.1016/j.medine.2024.06.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724001735?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569124002110?idApp=WMIE" "url" => "/02105691/0000004800000009/v1_202408290622/S0210569124002110/v1_202408290622/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>" "titulo" => "Nitric oxide as the third respiratory gas. A new opportunity to revisit the use of oxygen therapy in clinical practice" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "543" "paginaFinal" => "545" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Manuel Valencia-Gallardo, Felipe Rodríguez de Castro, Jordi Solé-Violán, José Carlos Rodríguez-Gallego" "autores" => array:4 [ 0 => array:4 [ "nombre" => "José Manuel" "apellidos" => "Valencia-Gallardo" "email" => array:1 [ 0 => "jvalgal@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Felipe" "apellidos" => "Rodríguez de Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Jordi" "apellidos" => "Solé-Violán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "José" "apellidos" => "Carlos Rodríguez-Gallego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Respiratory Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Professor of Medicine, Department of Medical and Surgical Sciences, School of Medicine, University of Las Palmas de Gran Canaria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Immunology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Óxido nítrico como tercer gas respiratorio. Una nueva ocasión para revisar el empleo de oxigenoterapia en la práctica clínica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1346 "Ancho" => 2508 "Tamanyo" => 287674 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Allosteric linkage of Hb conformation to O<span class="elsevierStyleInf">2</span> and SNO release. Left (Hb in red): cooperativity leads to Hb in the lung being able to bind oxygen molecules. Oxygenated Hb will also bind and stabilize SNO at Hb. Right (Hb in blue): upon reaching hypoxic tissues, Hb will cooperatively release oxygen molecules during transition to the deoxygenated state. Liberation of oxygen also causes the transfer of SNO from deoxygenated Hb to other erythrocyte thiols (R-S-H) and ultimately shuttling SNO out of red blood cells. Thus, Hb deoxygenation in tissues will lead to vasorelaxation (SNO-mediated vasodilation). Adapted from reference 6, with permission.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">New drug development requires accurate evaluation of efficacy and understanding of the underlying physiology.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Old therapies, as oxygen therapy, should not be exempt from such demands. We have now the opportunity to consider a more rational use of oxygen therapy in clinical practice<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> focusing on the role of hemoglobin in improving oxygen delivery to tissues.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Almost twenty years ago, McNulty and colleagues<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> demonstrated that in patients with stable coronary artery disease, administration of 100% oxygen increased coronary vascular resistance and reduced coronary blood flow compared to breathing room air. This increase in vascular resistance could be explained by the oxidative degradation of endothelial nitric oxide (NO) caused by reactive oxygen species generated under hyperoxic conditions.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Moreover, there is strong evidence that NO bioactivity is not restricted to the vascular endothelium. Hemoglobin can also incorporate stable metabolites of NO into the red blood cell (RBCs) environment.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In pulmonary circulation, oxygenation of Hb facilitates NO uptake to form S-nitrosohemoglobin (SNO-Hb) while, in the peripheral circulation, deoxygenation facilitates the transfer of S-nitrosothiols (SNOs) out of RBCs.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since SNOs promote vasodilation, the release of NO from Hb to a hypoxic environment result in increased blood flow to hypoxic tissues and would explain the physiological significance of SNO-Hb improving tissue oxygenation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In other words, the bioavailability of NO in vivo could be directly and effectively coupled to the oxygen saturation of Hb, not PO<span class="elsevierStyleInf">2</span>, so oxyhemoglobin (SaO<span class="elsevierStyleInf">2</span>) would establish a dynamic regulation of oxygenated blood flow in the microcirculation.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> This complementary activity of Hb provides a more efficient interpretation of its function. Rather than being considered a mere “transporter”, Hb would now ensure an optimal tissue oxygen supply.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">This alternative interpretation of the Hb role would promote the implementation of a targeted oxygenation with potential implications in clinical practice. In this regard, a judicious use of oxygen therapy would prevent the toxic effects of hyperoxia<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and focus the clinician's concern on maintaining a SaO<span class="elsevierStyleInf">2</span> value within a safety range.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As a result, two remarks should be taken account:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0035" class="elsevierStylePara elsevierViewall">SaO<span class="elsevierStyleInf">2</span> target of 100% should be avoided. Hemoglobin releases SNOs as blood becomes deoxygenated.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Therefore, a SaO<span class="elsevierStyleInf">2</span> value far from 100% would preserve the vasodilator function of partial Hb deoxygenation.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0040" class="elsevierStylePara elsevierViewall">The upper inflection point in the oxygen hemoglobin dissociation curve would represent the nadir in the optimal supply of O<span class="elsevierStyleInf">2</span>. Consequently, a SaO<span class="elsevierStyleInf">2</span> value closer to 90% could be a safe threshold. Ideal SaO<span class="elsevierStyleInf">2</span> have not been precisely established and may vary depending on clinical features,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> but in terms of adverse outcomes, recent randomized clinical trials have demonstrated no superiority of maintaining higher values of SaO<span class="elsevierStyleInf">2,</span> and even fewer complications with the use of more restrictive oxygen therapy strategy among critically ill patients.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> It is important to remember that not only PaO<span class="elsevierStyleInf">2</span> is almost irrelevant in oxygen delivery (DO<span class="elsevierStyleInf">2</span>) to the tissues but also high PaO<span class="elsevierStyleInf">2</span> values could increase mortality.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">In addition, to ensure adequate tissue oxygenation, a sufficient Hb level must be maintained. As with SaO<span class="elsevierStyleInf">2</span>, determining the optimal Hb level in specific clinical scenarios has been the goal of several guidelines<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> but discussion of this topic is beyond the scope of this paper. In any case, the decision to administer a blood transfusion should be based on clinical judgement of the individual's risk/benefit ratio, including risks associated with anemia and transfusion.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">All of the above would be consistent arguments for promoting automatic titration systems for oxygen therapy at bedside. Although it is a not widely implemented monitoring procedure, initial findings suggest an improvement in controlling target SO<span class="elsevierStyleInf">2</span> compared with manual titration and could improve morbidity and mortality and reduce care costs.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In short, scientific evidence supports a vasoactive role of Hb that would make it possible to better appreciate the tissue oxygenation optimizing function of Hb; it could also reinforce the prudent use of oxygen therapy if NO is considered as the third respiratory gas.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Author contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Conception and design: J.M. Valencia-Gallardo, F. Rodríguez -de Castro, J. Solé-Violán, J.C. Rodríguez-Gallego.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Collection, analysis and interpretation of the data: J.M. Valencia-Gallardo, F. Rodríguez de Castro, J. Solé-Violán, J.C. Rodríguez-Gallego.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Final approval of the article: J.M. Valencia-Gallardo, F. Rodríguez de Castro, J. Solé-Violán, J.C. Rodríguez-Gallego.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0075" class="elsevierStylePara elsevierViewall">This work is unfunded.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Disclosures</span><p id="par0080" class="elsevierStylePara elsevierViewall">Authors have disclosed no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Author contributions" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Disclosures" ] 3 => array:2 [ "identificador" => "xack769238" "titulo" => "Acknowledgment" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1346 "Ancho" => 2508 "Tamanyo" => 287674 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Allosteric linkage of Hb conformation to O<span class="elsevierStyleInf">2</span> and SNO release. Left (Hb in red): cooperativity leads to Hb in the lung being able to bind oxygen molecules. Oxygenated Hb will also bind and stabilize SNO at Hb. Right (Hb in blue): upon reaching hypoxic tissues, Hb will cooperatively release oxygen molecules during transition to the deoxygenated state. Liberation of oxygen also causes the transfer of SNO from deoxygenated Hb to other erythrocyte thiols (R-S-H) and ultimately shuttling SNO out of red blood cells. Thus, Hb deoxygenation in tissues will lead to vasorelaxation (SNO-mediated vasodilation). Adapted from reference 6, with permission.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oxygen delivery in the treatment of anemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.F. Bunn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra2212266" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2022" "volumen" => "387" "paginaInicial" => "2362" "paginaFinal" => "2365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36546628" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Translated article]. Oxygen therapy. Considerations regarding its use in acute ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Valencia-Gallardo" 1 => "J. Solé-Violán" 2 => "F. Rodríguez de Castro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2021.03.019" "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol." "fecha" => "2022" "volumen" => "58" "paginaInicial" => "102" "paginaFinal" => "103" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.H. McNulty" 1 => "N. King" 2 => "S. Scott" 3 => "G. Hartman" 4 => "J. McCann" 5 => "M. Kozak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/ajpheart.00625.2004" "Revista" => array:6 [ "tituloSerie" => "Am J Physiol Heart Circ Physiol." "fecha" => "2005" "volumen" => "288" "numero" => "3" "paginaInicial" => "1057" "paginaFinal" => "1062" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "S-nitrosohaemoglobin: a dynamic activity of blood involved in vascular control" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Jia" 1 => "C. Bonaventura" 2 => "J. Bonaventura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/380221a0" "Revista" => array:7 [ "tituloSerie" => "Nature." "fecha" => "1996" "volumen" => "380" "numero" => "6571" "paginaInicial" => "221" "paginaFinal" => "226" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8637569" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemoglobin, nitric oxide and molecular mechanisms of hypoxic vasodilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.W. Allen" 1 => "J.S. Stamler" 2 => "C.A. Piantadosi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.molmed.2009.08.002" "Revista" => array:7 [ "tituloSerie" => "Trends Mol Med." "fecha" => "2009" "volumen" => "15" "numero" => "10" "paginaInicial" => "452" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19781996" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Essential role of hemoglobin βCys93 in cardiovascular physiology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.T. Premont" 1 => "J.S. Stamler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/physiol.00040.2019" "Revista" => array:7 [ "tituloSerie" => "Physiology" "fecha" => "2020" "volumen" => "35" "numero" => "4" "paginaInicial" => "234" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32490751" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New perspectives in oxygen therapy titration: is automatic titration the future?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Mayoralas-Alises" 1 => "J.M. Carratalá" 2 => "S. Díaz-Lobato" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2018.09.006" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol." "fecha" => "2019" "volumen" => "55" "paginaInicial" => "319" "paginaFinal" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30414709" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit the oxygen-ICU randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Girardis" 1 => "S. Busani" 2 => "E. Damiani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2016.11993" "Revista" => array:7 [ "tituloSerie" => "JAMA" "fecha" => "2016" "volumen" => "316" "numero" => "15" "paginaInicial" => "1583" "paginaFinal" => "1589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27706466" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oxygen-saturation targets for critically ill. Adults receiving mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.W. Semler" 1 => "J.D. Casey" 2 => "B.D. Lloyd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2022" "volumen" => "387" "paginaInicial" => "1759" "paginaFinal" => "1769" "itemHostRev" => array:3 [ "pii" => "S187705681830344X" "estado" => "S300" "issn" => "18770568" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. De Jonge" 1 => "L. Peelen" 2 => "P.J. Keijzers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc7150" "Revista" => array:5 [ "tituloSerie" => "Crit Care." "fecha" => "2008" "volumen" => "12" "paginaInicial" => "R156" "itemHostRev" => array:3 [ "pii" => "S1877056818303268" "estado" => "S300" "issn" => "18770568" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Retter" 1 => "D. Wyncoll" 2 => "R. Pearse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.12143" "Revista" => array:7 [ "tituloSerie" => "Br J Haematol" "fecha" => "2013" "volumen" => "160" "paginaInicial" => "445" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23278459" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1063458414013892" "estado" => "S300" "issn" => "10634584" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Red blood cell transfusion 2023 AABB international guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.K. Carson" 1 => "S.J. Stanworth" 2 => "P.G. Guyatt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2023.12914" "Revista" => array:8 [ "tituloSerie" => "JAMA" "fecha" => "2023" "volumen" => "330" "numero" => "19" "paginaInicial" => "1892" "paginaFinal" => "1902" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37824153" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0749806317312768" "estado" => "S300" "issn" => "07498063" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack769238" "titulo" => "Acknowledgment" "texto" => "<p id="par0085" class="elsevierStylePara elsevierViewall">The authors thank Rebeca Sicilia-Torres, MD, and Marta Cuyás-Cortadellas, MD, for their thoughtful input on this work.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/02105691/0000004800000009/v1_202408290622/S0210569124002341/v1_202408290622/en/main.assets" "Apartado" => array:4 [ "identificador" => "437" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Punto de vista" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004800000009/v1_202408290622/S0210569124002341/v1_202408290622/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569124002341?idApp=WMIE" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 25 | 2 | 27 |
| 2024 Septiembre | 18 | 14 | 32 |
| 2024 Agosto | 17 | 7 | 24 |
