Heparina nebulizada en insuficiencia respiratoria aguda grave: revisión narrativa desde la coagulopatía pulmonar local hacia la terapia fenotipo-dirigida
DOI:
https://doi.org/10.65920/rpmed.202612.32Palabras clave:
heparina nebulizada, heparina inhalada, insuficiencia respiratoria agudaResumen
La insuficiencia respiratoria aguda grave y el síndrome de dificultad respiratoria aguda (SDRA) continúan siendo un problema central en la medicina de urgencias y cuidados críticos. La coagulopatía pulmonar local, el depósito intraalveolar de fibrina, la microtrombosis y la inflamación broncoalveolar han renovado el interés por terapias inhaladas capaces de modular mecanismos intrapulmonares. Esta revisión narrativa sintetiza críticamente la evidencia fisiopatológica, preclínica y clínica sobre heparina nebulizada en SDRA, COVID-19, injuria inhalatoria por humo o quemaduras y otros escenarios de pacientes críticos ventilados. La evidencia mecanística respalda efectos anticoagulantes y antiinflamatorios locales, mientras que los estudios clínicos muestran resultados heterogéneos: señales favorables en oxigenación, días libres de ventilador o progresión a la intubación en fenotipos seleccionados, junto con estudios negativos o limitados en SDRA general e injuria inhalatoria. La interpretación más consistente no es la de una terapia universal, sino la de una intervención adyuvante potencialmente útil en pacientes con coagulopatía alveolar, depósito de fibrina, microtrombosis, inflamación local u obstrucción broncoalveolar. Su implementación requiere selección fenotípica, inicio oportuno, estandarización de dosis y dispositivos, monitorización de seguridad y control de los circuitos ventilatorios.
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Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
