Monitorización de la presión intracraneal en traumatismo craneoencefálico severo

El traumatismo craneoencefálico severo (TCES) es una entidad grave. La monitorización de la presión intracraneal (PIC) permite dirigir el tratamiento, el cual es de limitado acceso en países en vías de desarrollo. Describir la experiencia clínica de pacientes pediátricos con TCES. Se incluyeron paci...

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Published inRevista Chilena de pediatría Vol. 87; no. 5; pp. 387 - 394
Main Authors García-Lira, José Ramón, Zapata-Vázquez, Rita Esther, Alonzo-Vázquez, Felipe, Rodríguez-Ruz, Suemy Gabriela, Medina-Moreno, Manuel Rene, Torres-Escalante, Jose Luis
Format Journal Article
LanguageSpanish
Portuguese
Published Elsevier España, S.L.U 01.09.2016
Sociedad Chilena de Pediatría
Subjects
Cerebral perfusion pressure
Intracranial pressure
PEDIATRICS
Presión de perfusión cerebral
Presión intracraneal
Prognostic
Pronóstico
Traumatic brain injury
Traumatismo craneoencefálico
Pronóstico
Traumatic brain injury
Presión intracraneal
Presión de perfusión cerebral
Intracranial pressure
Cerebral perfusion pressure
Prognostic
Traumatismo craneoencefálico
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Abstract El traumatismo craneoencefálico severo (TCES) es una entidad grave. La monitorización de la presión intracraneal (PIC) permite dirigir el tratamiento, el cual es de limitado acceso en países en vías de desarrollo. Describir la experiencia clínica de pacientes pediátricos con TCES. Se incluyeron pacientes con TCES, edad entre 1 y 17 años, previo consentimiento informado de los padres y/o tutores. Se excluyeron pacientes con enfermedades crónicas o retraso psicomotor. Los pacientes ingresaron desde el Servicio de Urgencia, donde se les realizó scanner cerebral (TAC), clasificándose las lesiones por Escala de Marshall. Los pacientes fueron divididos en 2 grupos según criterio neuroquirúrgico: con monitorización (CM) y sin monitorización (SM) de presión intracraneana. La monitorización de la PIC se realizó a través de un catéter intraparenquimatoso 3PN Spiegelberg conectado a un monitor Spiegelberg HDM 26. Los pacientes fueron tratados de acuerdo a las guías pediátricas para TCES. Se consideró la supervivencia como los días transcurridos entre el ingreso hospitalario y el fallecimiento, o su evaluación por Escala de Glasgow para un seguimiento de 6 meses. Cuarenta y dos pacientes (CM = 14 y SM= 28). Aquellos con monitorización tenían menor puntuación de la escala de coma de Glasgow y clasificación de Marshall con peor pronóstico. En ellos la supervivencia fue menor y el resultado moderado a bueno. No se registraron complicaciones con el uso del catéter de PIC. Pacientes con monitorización tuvieron mayor gravedad al ingreso y una mayor mortalidad; sin embargo, el resultado funcional de los sobrevivientes fue de moderado a bueno. Se requiere de la realización de ensayos clínicos aleatorizados para definir el impacto de la monitorización de la PIC en la supervivencia y calidad de vida en estos pacientes. Severe traumatic brain injury (TBI) is a serious condition. Intracranial pressure (ICP) monitoring can be used to direct treatment, which is of limited access in developing countries. To describe the clinical experience of pediatric patients with severe TBI. A clinical experience in patients with severe TBI was conducted. Age was 1–17 years, exclusion criteria were chronic illness and psicomotor retardation. Informed consent was obtained in each case. Two groups were formed based on the criterion of neurosurgeons: with and without intracraneal pressure (ICP) monitoring. PIC monitoring was performed through a 3PN Spiegelberg catheter and a Spiegelberg HDM 26 monitor. Patients were treated according international pediatric guides. The characteristics of both groups are described at 6 months of follow-up. Forty-two patients (CM=14 and SM=28). Those in the CM Group had lower Glasgow coma scale score and Marshall classification with poorer prognosis. Among them survival rate was lower, although the outcome was from moderate to good. No complications were reported with the use of the ICP catheter. Patients with ICP monitoring had greater severity at admission and an increased mortality; however, the outcome for the survivors was from moderate to good. It is necessary to conduct randomized clinical trials to define the impact of ICP monitoring on survival and quality of life in severe TBI patients.
AbstractList Introducción: El traumatismo craneoencefálico severo (TCES) es una entidad grave. La monitorización de la presión intracraneal (PIC) permite dirigir el tratamiento, el cual es de limitado acceso en países en vías de desarrollo. Objetivo: Describir la experiencia clínica de pacientes pediátricos con TCES. Pacientes y método: Se incluyeron pacientes con TCES, edad entre 1 y 17 años, previo consentimiento informado de los padres y/o tutores. Se excluyeron pacientes con enfermedades crónicas o retraso psicomotor. Los pacientes ingresaron desde el Servicio de Urgencia, donde se les realizó scanner cerebral (TAC), clasificándose las lesiones por Escala de Marshall. Los pacientes fueron divididos en 2 grupos según criterio neuroquirúrgico: con monitorización (CM) y sin monitorización (SM) de presión intracraneana. La monitorización de la PIC se realizó a través de un catéter intraparenquimatoso 3PN Spiegelberg conectado a un monitor Spiegelberg HDM 26. Los pacientes fueron tratados de acuerdo a las guías pediátricas para TCES. Se consideró la supervivencia como los días transcurridos entre el ingreso hospitalario y el fallecimiento, o su evaluación por Escala de Glasgow para un seguimiento de 6 meses. Resultados: Cuarenta y dos pacientes (CM = 14 y SM= 28). Aquellos con monitorización tenían menor puntuación de la escala de coma de Glasgow y clasificación de Marshall con peor pronóstico. En ellos la supervivencia fue menor y el resultado moderado a bueno. No se registraron complicaciones con el uso del catéter de PIC. Conclusión: Pacientes con monitorización tuvieron mayor gravedad al ingreso y una mayor mortalidad; sin embargo, el resultado funcional de los sobrevivientes fue de moderado a bueno. Se requiere de la realización de ensayos clínicos aleatorizados para definir el impacto de la monitorización de la PIC en la supervivencia y calidad de vida en estos pacientes.
El traumatismo craneoencefálico severo (TCES) es una entidad grave. La monitorización de la presión intracraneal (PIC) permite dirigir el tratamiento, el cual es de limitado acceso en países en vías de desarrollo. Describir la experiencia clínica de pacientes pediátricos con TCES. Se incluyeron pacientes con TCES, edad entre 1 y 17 años, previo consentimiento informado de los padres y/o tutores. Se excluyeron pacientes con enfermedades crónicas o retraso psicomotor. Los pacientes ingresaron desde el Servicio de Urgencia, donde se les realizó scanner cerebral (TAC), clasificándose las lesiones por Escala de Marshall. Los pacientes fueron divididos en 2 grupos según criterio neuroquirúrgico: con monitorización (CM) y sin monitorización (SM) de presión intracraneana. La monitorización de la PIC se realizó a través de un catéter intraparenquimatoso 3PN Spiegelberg conectado a un monitor Spiegelberg HDM 26. Los pacientes fueron tratados de acuerdo a las guías pediátricas para TCES. Se consideró la supervivencia como los días transcurridos entre el ingreso hospitalario y el fallecimiento, o su evaluación por Escala de Glasgow para un seguimiento de 6 meses. Cuarenta y dos pacientes (CM = 14 y SM= 28). Aquellos con monitorización tenían menor puntuación de la escala de coma de Glasgow y clasificación de Marshall con peor pronóstico. En ellos la supervivencia fue menor y el resultado moderado a bueno. No se registraron complicaciones con el uso del catéter de PIC. Pacientes con monitorización tuvieron mayor gravedad al ingreso y una mayor mortalidad; sin embargo, el resultado funcional de los sobrevivientes fue de moderado a bueno. Se requiere de la realización de ensayos clínicos aleatorizados para definir el impacto de la monitorización de la PIC en la supervivencia y calidad de vida en estos pacientes. Severe traumatic brain injury (TBI) is a serious condition. Intracranial pressure (ICP) monitoring can be used to direct treatment, which is of limited access in developing countries. To describe the clinical experience of pediatric patients with severe TBI. A clinical experience in patients with severe TBI was conducted. Age was 1–17 years, exclusion criteria were chronic illness and psicomotor retardation. Informed consent was obtained in each case. Two groups were formed based on the criterion of neurosurgeons: with and without intracraneal pressure (ICP) monitoring. PIC monitoring was performed through a 3PN Spiegelberg catheter and a Spiegelberg HDM 26 monitor. Patients were treated according international pediatric guides. The characteristics of both groups are described at 6 months of follow-up. Forty-two patients (CM=14 and SM=28). Those in the CM Group had lower Glasgow coma scale score and Marshall classification with poorer prognosis. Among them survival rate was lower, although the outcome was from moderate to good. No complications were reported with the use of the ICP catheter. Patients with ICP monitoring had greater severity at admission and an increased mortality; however, the outcome for the survivors was from moderate to good. It is necessary to conduct randomized clinical trials to define the impact of ICP monitoring on survival and quality of life in severe TBI patients.
Author García-Lira, José Ramón
Zapata-Vázquez, Rita Esther
Alonzo-Vázquez, Felipe
Medina-Moreno, Manuel Rene
Rodríguez-Ruz, Suemy Gabriela
Torres-Escalante, Jose Luis
AuthorAffiliation Universidad Autónoma de Yucatán
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  givenname: José Ramón
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  organization: Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
– sequence: 2
  givenname: Rita Esther
  surname: Zapata-Vázquez
  fullname: Zapata-Vázquez, Rita Esther
  organization: Unidad Interinstitucional de Investigación Clínica y Epidemiológica, Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
– sequence: 3
  givenname: Felipe
  surname: Alonzo-Vázquez
  fullname: Alonzo-Vázquez, Felipe
  organization: Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
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  givenname: Suemy Gabriela
  surname: Rodríguez-Ruz
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  givenname: Manuel Rene
  surname: Medina-Moreno
  fullname: Medina-Moreno, Manuel Rene
  organization: Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
– sequence: 6
  givenname: Jose Luis
  surname: Torres-Escalante
  fullname: Torres-Escalante, Jose Luis
  organization: Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
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Issue 5
Keywords Pronóstico
Traumatic brain injury
Presión intracraneal
Presión de perfusión cerebral
Intracranial pressure
Cerebral perfusion pressure
Prognostic
Traumatismo craneoencefálico
Language Spanish
Portuguese
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Snippet El traumatismo craneoencefálico severo (TCES) es una entidad grave. La monitorización de la presión intracraneal (PIC) permite dirigir el tratamiento, el cual...
Introducción: El traumatismo craneoencefálico severo (TCES) es una entidad grave. La monitorización de la presión intracraneal (PIC) permite dirigir el...
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StartPage 387
SubjectTerms Cerebral perfusion pressure
Intracranial pressure
PEDIATRICS
Presión de perfusión cerebral
Presión intracraneal
Prognostic
Pronóstico
Traumatic brain injury
Traumatismo craneoencefálico
Title Monitorización de la presión intracraneal en traumatismo craneoencefálico severo
URI https://dx.doi.org/10.1016/j.rchipe.2016.04.006
http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062016000500009&lng=en&tlng=en
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