Arroyo MG, Salgado CJ, Fernández PO

Language: Spanish
References: 17
Page: 125-131
PDF size: 93.22 Kb.

ABSTRACT

Background. Traumatic cerebral injury is a common cause of morbimortality, which requires a specialized management at the intensive care unit.
Objective. To evaluate management and prognostic modification through invasive and noninvasive monitoring in severe cranial injury patients.
Method. Observational, prospective and longitudinal study of patients with severe cranial injury attended from November 1999 to May 2000, at the Military Central Hospital ICU.
Results. Twenty two patients were studied, mean age of 35.9 years old; mainly men (86.4%), with a score of 8 or less using the Glasgow scale. Features included cerebral edema in 90% of them; associated neurological injuries in 37%. The most frequent cause was car accident (63.6%). Monitoring included intracranial pressure measurement (50%), cerebral perfusion calculation (50%), electroencephalogram (33.8%) between other monitoring ways. A computed tomography was performed in 90%.
Conclusions. Computed tomography and intracranial pressure measurement were the procedures which modified management of cranial trauma patients. Prognosis is multifactorial.

REFERENCES

1. Caron MJ. Intracranial pressure. Part 1. Central nervous system physiology. Tindall. The practice of neurosurgery. In: Williams and Wilkins; 1996; p.70-97.

2. Marmarou A. Intracranial pressure: Physiology and pathophysiology. Cooper: Head injury. Williams and Wilkins; 1987; p. 159-76.

3. Muizelaar JP. Cerebral blood flow and metabolism in severely head injured children. J Neurosurg 1989; 71: 72-6.

4. Guyon LL, et al. Cerebral monitoring devices: Analysis of complications. Acta Neurochir Suppl. 1998; 71: 47-9.

5. Fernandes HM, et al. Clinical evaluation of a Codman microsensor intracranial pressure monitoring system. Acta Neurochir Suppl 1998; 71: 44-6.

6. Sahuquillo J, et al. Interhemispheric supratentorial intracranial pressure gradients in head-injured patients: Are they clinically important? J Neurosurg. 1999; 90(1): 16-26.

7. Coplin WM, et al. Accuracy of continuos jugular bulb oxymetry in the intensive care unit. Neurosurgery 1998; 42(3): 533-9.

8. Jeevaraitnam DR, et al. Survey of intensive care of severely head injured patients in the United Kingdom. BMJ 1996; 13; 312(7036): 944-7.

9. Gumey JG, et al. The effects of alcohol intoxication on the initial treatment and hospital course of patients with acute brain injury. J Trauma 1992; 33(5): 709-13.

10. Gopinath SP. Comparison of jugular venous oxygen saturation and brain tissue PO2 as monitors of cerebral ischemia after head injury. Crit Care Med 1999; 27(11): 2337-45.

11. Vespa PM, et al. Increased incidence and impact of non convulsive and convulsive seizures after traumatic brain injury as detected by continuos electroencephalographic monitoring. J Neurosurg 1999; 91(5): 750-60.

12. Bruzzone P, et al. Effects of cerebral perfusion pressure on brain tissue PO2 in patients with severe head injury. Acta Neurochir Suppl 1998; 71: 111-13.

13. Kamplf A, et al. The persistent vegetative state after closed head injury: Clinical and magnetic resonance imaging findings in 42 patients. J Neurosurg 1998; 88(5): 809-16.

14. Newell DW, et al. Effect of transient moderate hiperventilation on dynamic cerebral autoregulation after severe head injury. Neurosurgery 1996; 39(1): 35-43.

15. Kroppenstedt SN, et al. Effect of cerebral perfusion pressure on contusion volume following impact injury. J Neurosurg 1999; 90(3): 520-6.

16. Clifton GL. Hypothermia and hyperbaric oxygen as treatment modalities for severe head injury. New Horiz 1995; 3(3): 474-8.

17. Simma B, et al. A prospective, randomized, and controlled study of fluid managment in children with sever head injury: Lactate Ringer’s solution versus hypertonic saline. Crit Care Med 1998; 26(7): 1265-70.