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«Ojo» a los broncodilatadores en nebulización
Beware of Nebulized Bronchodilators
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B)<span class="elsevierStyleHsp" style=""></span>TCev coronal: masa hiliar derecha (flecha discontinua) que realza tras la administración de contraste y que causa atelectasia de LID (flecha continua). C)<span class="elsevierStyleHsp" style=""></span>SPECT-TC torácico. Corte coronal: foco de hipercaptación del trazador en la región hiliar derecha compatible con TNE (flecha discontinua). Otro foco de menor intensidad, inferior a éste, situado en una zona de neumonitis con atelectasia (flechas continuas). D)<span class="elsevierStyleHsp" style=""></span>SPECT-TC torácica. 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Marcos" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Lucía" "apellidos" => "Ferreira-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Trigás-Ferrín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "Pedro J." "apellidos" => "Marcos" "email" => array:1 [ 0 => "pedro.jorge.marcos.rodriguez@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Complexo Hospitalario Universitario de Ferrol (CHUF), SERGAS, Ferrol, A Coruña, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Complexo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), SERGAS, A Coruña, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Beware of Nebulized Bronchodilators" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1374 "Ancho" => 1706 "Tamanyo" => 649902 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paciente varón de 75<span class="elsevierStyleHsp" style=""></span>años con antecedentes de cardiopatía valvular y fibrilación auricular permanente que ingresa por insuficiencia respiratoria hipoxémica grave en el contexto infección bronquial por virus Influenza A H1N1. Como tratamiento recibió oseltamivir y bromuro de ipratropio (BI) en nebulización a través de mascarilla facial. El día posterior al ingreso se apreció en el examen físico anisocoria con midriasis fija de la pupila derecha (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>A). Dado que el paciente se encontraba asintomático, sin cefalea, dolor ocular ni focalidad neurológica, se opta por actitud expectante y retirada de BI nebulizado. A las 24<span class="elsevierStyleHsp" style=""></span>h de interrumpir el tratamiento se observa resolución de la alteración pupilar, con pupilas isocóricas y normorreactivas (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El empleo generalizado de los broncodilatadores en nebulización es una práctica cada vez más extendida. Se han descrito distintas complicaciones asociadas a su uso, y concretamente asociadas al BI se encuentra la anisocoria, como la descrita, o más graves, como la precipitación de glaucoma de ángulo agudo<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Detectar a los potenciales pacientes en riesgo, valorar otras formas de administración como los dispositivos bucales o el empleo de gafas de protección podrían ser medidas importantes a considerar para evitar el desarrollo de estas complicaciones<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1374 "Ancho" => 1706 "Tamanyo" => 649902 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ipratropium bromide induced angle closure glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.T. Malani" 1 => "G.M. Robinson" 2 => "E.L. Seneviratne" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Z Med J" "fecha" => "1982 27" "volumen" => "95" "paginaInicial" => "749" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6216428" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glaucoma agudo de ángulo cerrado y bromuro de ipratropio" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Ortiz Rambla" 1 => "J.J. Hidalgo Mora" 2 => "G. Gascón Ramón" 3 => "B. Navarro Arambudd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2005" "volumen" => "124" "paginaInicial" => "795" "paginaFinal" => "799" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005100000003/v2_201502240247/S0300289614001720/v2_201502240247/es/main.assets" "Apartado" => array:4 [ "identificador" => "21422" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images / Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005100000003/v2_201502240247/S0300289614001720/v2_201502240247/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614001720?idApp=UINPBA00003Z" ]
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