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Journal Information
Vol. 3. Issue 4.
Pages 285-298 (January 1992)
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Vol. 3. Issue 4.
Pages 285-298 (January 1992)
Monitorización de la hemodinámica cerebral en los traumatismos craneoencefálicos graves a partir de las diferencias arterioyugulares de oxígeno. Fundamentos, metodología e indicaciones
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M.A. Poca, J. Sauquillo, A. Chasampi, F. Coello, F. Ramírez, E. Rubio
Servicio de Neurocirugía. Hospital Vall d’Hebron. Barcelona
A. Robles*, C. Triginer*, A. Gamacho*, M.D. Pelegri**
* Unidad de Vigilancia Intensiva de Neurotraumatología. Hospital Vall d’Hebron. Barcelona
** Servicio de Bioquímica. Hospital Vall d’Hebron. Barcelona
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Resumen

Estudios recientes han demostrado la importancia de las lesiones secundarias en el resultado final de los pacientes afectos de un traumatismo craneoencefálico grave (TCEG). Entre las lesiones secundarias, revisten una especial importancia las lesiones hipóxico-isquémicas cerebrales. La potencial reversibilidad en algunos casos de las lesiones isquémicas, sugiere la necesidad de un diagnóstico precoz y adecuado de las mismas. La monitorización de la hemodinámica y del metabolismo cerebral a partir de las diferencias arteriovenosas de oxígeno y lactatos, permite detectar alteraciones del metabolismo energético celular.

A pesar de que diversos autores preconizan este sistema de monitorización, la literatura que existe al respecto es escasa y controvertida. En este trabajo pretendemos exponer los fundamentos, indicaciones y limitaciones del método, ya que su uso rutinario puede contribuir a la racionalización de las medidas terapéuticas y, en último término, a mejorar el pronóstico de los pacientes con un TCE grave.

Palabras clave:
Traumatismo craneoencefálico
Flujo sanguíneo cerebral
Metabolismo cerebral
Diferencias arteriovenosas de oxígeno
Lactato
Bulbo yugular
Catéter yugular retrogrado
Isquemia
Summary

Recent studies have shown the importance of secondary lesions in the final outcome of patients suffering from severe head injury. Among secondary lesions, hypoxic-ischemic injury is of special importance. Possible reversibility of ischemic damage suggests the need of an early diagnosis of these lesions. Monitorization of hemodynamics and cerebral metabolism by measuring the arteriovenous differences of oxygen and lactates may allow to detect significant alterations in brain metabolism. Some authors have considered this method of monitoring to be controversial. The object of this study is to describe the basic methodology, the indications and the limitations of this method wich may contribute to the rationalitation of therapeutic manouvers and improve the final outcome of severe head injuried patients.

Key words:
Severe head injury
Cerebral blood flow
Cerebral metabolism
Arteriovenous differences of oxygen
Lactate
Jugular bulb
Reverse jugular catheter
Ischemia

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