Valor del óxido nítrico nasal en el diagnóstico de la discinesia ciliar primaria

Moreno‐Galdó, Antonio; Lamotte, G. Vizmanos; Bover, Conrado Reverté; Gartner, Sílvia; Barroso, Nicolás Cobos; Amigό, Sandra Rovira; Cortés, Santos Liñán; Trull, Josep Lloreta; Monge, Romain

doi:10.1016/j.anpedi.2009.10.026

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…It is unclear why this study found bronchiectasis patients to have lower levels than those reported in other studies, but participant numbers were low [24] and the bronchiectasis group may have contained a number of undiagnosed PCD patients. PCD patients nNO was also significantly lower than patients with asthma [19,24,30,31], chronic obstructive pulmonary disease (COPD) [19,28] and humoral immunodeficiency [31].…”

Section: Study Selection and Risk Of Biascontrasting

confidence: 54%

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Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis

et al. 2014

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Nasal nitric oxide (nNO) concentrations are low in patients with primary ciliary dyskinesia (PCD) providing a noninvasive screening test.We conducted a systematic review of the literature to examine the utility of nNO in screening for PCD, in particular 1) different respiratory manoeuvres during sampling (velum closure, tidal breathing, etc.), 2) accuracy in screening young/uncooperative children, 3) stationary versus portable analysers, and 4) nNO in ''atypical'' PCD.96 papers were assessed according to modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and 22 were included in this review.Meta-analysis of 11 studies comparing nNO during a velum closure breath hold gave a mean¡SD nNO of 19.4¡18.6 nL?min -1 in PCD (n5478) and 265.0¡118.9 nL?min -1 in healthy controls (n5338). Weighted mean difference for PCD versus healthy controls was 231.1 nL?min -1 (95% CI 193.3-268.9; n5338) and 114.1 nL?min -1 (95% CI 101.5-126.8; n5415) for PCD versus cystic fibrosis. Five studies of nNO measurement during tidal breathing demonstrated that this is an acceptable manoeuvre in young children where velum closure is not possible, but the discriminatory value was reduced. Four small studies of portable NO analysers suggest these are reliable tools for screening for PCD. However, nNO must be interpreted alongside clinical suspicion. Future studies should focus on standardising sampling techniques and reporting. @ERSpublications Nasal nitric oxide is a useful and increasingly versatile screening tool in primary ciliary dyskinesia at all ages http://ow.ly/AR5mqThis article has supplementary material available from erj.ersjournals.com

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Section: Study Selection and Risk Of Biascontrasting

confidence: 54%

“…Five reported similar nNO levels in bronchiectasis to healthy controls [7-9, 23, 26] and one used only a portable analyser in a small number of patients [28]. MORENO GALDÓ et al [24] reported lower nNO in bronchiectasis than in healthy participants (mean 90.3 nL?min -1 versus 224.5 nL?min…”

Section: Study Selection and Risk Of Biasmentioning

confidence: 99%

Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis

et al. 2014

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“…Four studies evaluated the diagnostic efficacy of nNO in cohorts of referred suspect patients for PCD testing [ 7 , 22 – 24 ] whereas the rest of the studies had a case–control design. Controls were non-PCD subjects, either healthy subjects only [ 22 , 25 – 28 ] or healthy subjects and patients with other respiratory diseases [ 14 , 29 – 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Controls were non-PCD subjects, either healthy subjects only [ 22 , 25 – 28 ] or healthy subjects and patients with other respiratory diseases [ 14 , 29 – 31 ].…”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of nasal nitric oxide for establishing diagnosis of primary ciliary dyskinesia: a meta-analysis

2015

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BackgroundTo date, diagnosis of Primary Ciliary Dyskinesia (PCD) remains difficult and challenging. We systematically evaluated the diagnostic performance of nasal Nitric Oxide (nNO) measurement for the detection of PCD, using either velum-closure (VC) or non-velum-closure (non-VC) techniques.MethodsAll major electronic databases were searched from inception until March 2015 using appropriate terms. The sensitivity and specificity of nNO measurement was calculated in PCD patients diagnosed by transmission electron microscopy, high speed video-microscopy or genetic testing. Summary receiver operating characteristic (HSROC) curves were drawn using the parameters of the fitted models.ResultsTwelve studies provided data for 13 different populations, including nine case–control (n = 793) and four prospective cohorts (n = 392). The overall sensitivity of nNO measured by VC techniques was 0.95 (95 % CI 0.91–0.97), while specificity was 0.94 (95 % CI 0.88–0.97). The positive likelihood ratio (LR+) of the test was 15.8 (95 % CI 8.1–30.6), whereas the negative likelihood ratio (LR-) was 0.06 (95 % CI 0.04–0.09). For non-VC techniques, the overall sensitivity of nNO measurement was 0.93 (95 % CI 0.89–0.96) whereas specificity was 0.95 (95 % CI 0.82–0.99). The LR+ of the test was 18.5 (95 % CI 4.6–73.8) whereas the LR- was 0.07 (95 % CI 0.04–0.12).ConclusionsDiagnostic accuracy of nNO measurement both with VC and non-VC maneuvers is high and can be effectively employed in the clinical setting to detect PCD even in young children, thus potentiating early diagnosis. Measurement of nNO merits to be part of a revised diagnostic algorithm with the most efficacious combination of tests to achieve PCD diagnosis.

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“…(15) En un estudio realizado, en pacientes pediátricos, se determinó que la concentración nasal de óxido nítrico posee una sensibilidad del 88,9 % y una especificidad del 99,1%. (16) Otro de los estudios es el del movimiento ciliar por videomicroscopía de alta velocidad, con sensibilidad del 96 %-100 % y especificidad del 93 %-95 %. (15) Por último, tenemos técnicas de inmunofluorescencia y estudios genéticos cuando la confirmación diagnóstica es difícil por otros métodos.…”

Section: Discussionunclassified

Uso del modo APRV en un paciente con discinesia ciliar primaria por distrés respiratorio agudo.

Carrión-Figueroa,

Peralta-Bravo,

Peña-Frías

et al. 2019

INSPILIP

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La discinesia ciliar primaria (DCP) es una enfermedad hereditaria muy rara que afecta la estructura y función ciliar, lo que favorece a las infecciones recurrentes e inflamación crónica de la vía aérea. La complicación más grave de la DCP es el síndrome de distrés respiratorio agudo (SDRA), cuya consecuencia es la aparición de shunt intrapulmonar, es decir, de poblaciones alveolares perfundidas, pero no ventiladas, provocando hipoxemia refractaria. La aplicación temprana de APRV (Airway pressure release ventilation) en pacientes con SDRA con relación pa02/Fio2 (PAFI) menor de 150, mejora la oxigenación, disminuye la duración de la ventilación mecánica y la permanencia en UCI. Presentamos el caso clínico de un paciente de 48 años con discinesia ciliar primaria (DCP), que desarrolló distrés respiratorio agudo requiriendo su ingreso en UCI para manejo ventilatorio mecánico invasivo; por no mejoría clínica ante la ventilación con modos ventilatorios convencionales, volumen (SCMV) y presión (PCMV), se opta por el modo APRV, presentando favorable evolución, con pronta recuperación y egreso hospitalario. La ventilación con liberación de presión en la vía aérea es una modalidad relativamente nueva de ventilación mecánica, que ha demostrado un mejoramiento en el reclutamiento alveolar, la oxigenación y el intercambio de gases, mientras se mantiene una aceptable presión pico de las vías respiratorias.

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Valor del óxido nítrico nasal en el diagnóstico de la discinesia ciliar primaria

Cited by 6 publications

References 23 publications

Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis

Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis

Diagnostic accuracy of nasal nitric oxide for establishing diagnosis of primary ciliary dyskinesia: a meta-analysis

Uso del modo APRV en un paciente con discinesia ciliar primaria por distrés respiratorio agudo.

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