Arébalo LM, Díaz CM, Candia GJF

Language: Spanish
References: 19
Page: 124-129
PDF size: 621.42 Kb.

ABSTRACT

Acute endocranial hypertension, of any etiology, is a medical emergency, requiring immediate intervention to prevent permanent damage to the brain by alterations in cerebral perfusion (normal from 60 to 150 mmHg). Therefore, mean arterial pressures > 90 mmHg, oxygen saturation > 90%, intracranial pressure monitoring, are recommended. Invasive monitoring of intracranial pressure with intraparenchymal or intraventricular catheter is the "gold standard" for traumatic brain injury (TBI), requires a surgical procedure, performed by a specialist, with risks such as bleeding, infection, malposition, device obstruction, device malfunction. On the other hand, the diagnosis by computed tomography also has its risks, the transfer of the patient and the delay in the diagnosis. Ultrasound is currently a non-invasive tool that can be performed at the patient's bedside; it measures the diameter of the optic nerve sheath, with an average procedure time of less than two minutes. The reviews of meta-analysis studies recommend the use of optic nerve ultrasound, especially in places where there is no invasive monitoring, they report that it has a sensitivity of 0.90 (95%CI 0.80-0.95) and specificity of 0.85 (95%CI 0.73-0.93), with an average cut-off point of the diameter of the optic nerve sheath from 5.0 to 5.9 mm to determine whether it is endocranial hypertension. The use of optic nerve ultrasound, has limitations such as patients with subarachnoid hemorrhage secondary to aneurysm rupture, concomitant with hydrocephalus, eye trauma, neuronitis and optic nerve atrophy.

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