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    "titulo" => "Actualizaciones en los m&#233;todos de monitorizaci&#243;n cerebral regional en los pacientes neurocr&#237;ticos&#58; presi&#243;n tisular de ox&#237;geno&#44; microdi&#225;lisis cerebral y t&#233;cnicas de espectroscop&#237;a por infrarrojos"
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        "titulo" => "Recent advances in regional cerebral monitoring in the neurocritical patient&#58; brain tissue oxygen pressure monitoring&#44; cerebral microdialysis and near-infrared spectroscopy"
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            1 => "Brain metabolism"
            2 => "Tissular oxygenation"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El resultado final de los pacientes que han presentado un traumatismo craneoencef&#225;lico &#40;TCE&#41; depende de las lesiones primarias&#44; pero tambi&#233;n&#44; y en gran medida&#44; de las lesiones secundarias&#46; El diagn&#243;stico de un gran n&#250;mero de lesiones secundarias&#44; y en especial de la isquemia cerebral&#44; se centra en la monitorizaci&#243;n simult&#225;nea de diversas variables encef&#225;licas y sist&#233;micas&#46; En el momento actual&#44; la monitorizaci&#243;n continua de la presi&#243;n intracraneal &#40;PIC&#41; se considera una medida indispensable en el manejo de los pacientes con un TCE grave que presentan cualquier tipo de lesi&#243;n intracraneal&#46; Sin embargo&#44; la informaci&#243;n que ofrece esta variable es insuficiente para diagnosticar los complejos procesos fisiopatol&#243;gicos que caracterizan a las lesiones neurotraum&#225;ticas&#46; Por ello&#44; cada vez es m&#225;s frecuente complementar la neuromonitorizaci&#243;n de los pacientes con un TCE con m&#233;todos de estimaci&#243;n del flujo sangu&#237;neo cerebral &#40;FSC&#41; como el Doppler transcraneal o las t&#233;cnicas de oximetr&#237;a yugular&#46; Sin embargo&#44; en el momento actual y en la cabecera del paciente&#44; el conocimiento de la repercusi&#243;n de las lesiones tisulares y de las medidas terap&#233;uticas sobre el metabolismo cerebral requiere un acceso directo al par&#233;nquima encef&#225;lico&#46; En esta revisi&#243;n nos centraremos en tres m&#233;todos de monitorizaci&#243;n cerebral &#8220;regional&#8221;&#58; la presi&#243;n tisular de ox&#237;geno&#44; la microdi&#225;lisis cerebral y las t&#233;cnicas transcut&#225;neas de espectroscop&#237;a por infrarrojos&#46; En cada caso se expondr&#225;n los fundamentos del m&#233;todo en cuesti&#243;n&#44; los valores de referencia de los par&#225;metros monitorizados y una serie de recomendaciones sobre c&#243;mo pueden interpretarse sus resultados a la luz de los conocimientos actuales&#46;</p>"
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        "titulo" => "Summary"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The long term outcome of head-injured patients depends not only on the primary brain lesions but also to a large extent on the secondary lesions&#46; The diagnosis of many secondary lesions&#44; and specially that of brain ischemia&#44; is based on simultaneous monitoring of several intracranial and systemic variables&#46; Continuous intracranial pressure &#40;ICP&#41; monitoring is currently considered indispensable in the management of all patients with a severe head injury and intracranial lesions&#46; However&#44; the information provided by this technique is insufficient to diagnose some of the complex physiopathological processes that characterize traumatic brain lesions&#46; Consequently&#44; the use of methods to estimate cerebral blood flow such as transcranial Doppler and jugular oximetry to complement ICP monitoring is becoming increasingly widespread&#46; Nevertheless&#44; determining the effect of tissue lesions and therapeutic measures on cerebral metabolism currently requires direct access to the brain parenchyma at the bedside&#46; In this review we focus on three methods of regional cerebral monitoring&#58; oxygen tissue pressure &#40;PtiO<span class="elsevierStyleInf">2</span>&#41; monitoring&#44; microdialysis and near-infrared spectroscopy&#46; The bases of each method and reference values for the variables analyzed will be discussed&#46; We also make a series of recommendations on how results should be interpreted in light of current knowledge&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Poca&#44; M&#46;A&#46;&#59; Sahuquillo&#44; J&#46;&#59; Mena&#44; M&#46;P&#46;&#59; Vilalta&#44; A&#46;&#59; Riveiro&#44; M&#46;&#58; Actualizaciones en los m&#233;todos de monitorizaci&#243;n cerebral regional en los pacientes neurocr&#237;ticos&#58; presi&#243;n tisular de ox&#237;geno&#44; microdi&#225;lisis cerebral y t&#233;cnicas de espectroscop&#237;a por infrarrojos&#46; Neurocirug&#237;a 2005&#59; 16&#58; 385&#8211;410&#46;</p>"
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Vol. 16. Núm. 5.
Páginas 385-409 (enero 2004)
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Vol. 16. Núm. 5.
Páginas 385-409 (enero 2004)
Actualizaciones en los métodos de monitorización cerebral regional en los pacientes neurocríticos: presión tisular de oxígeno, microdiálisis cerebral y técnicas de espectroscopía por infrarrojos
Recent advances in regional cerebral monitoring in the neurocritical patient: brain tissue oxygen pressure monitoring, cerebral microdialysis and near-infrared spectroscopy
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M.P. Mena, A. Vilalta
Unidad de Investigación de Neurotraumatología. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. Barcelona
M.A. Poca*,
, J. Sahuquillo*, M. Riveiro**
* Servicio de Neurocirugía. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. Barcelona
** Unidad de Cuidados Intensivos. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. Barcelona
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El resultado final de los pacientes que han presentado un traumatismo craneoencefálico (TCE) depende de las lesiones primarias, pero también, y en gran medida, de las lesiones secundarias. El diagnóstico de un gran número de lesiones secundarias, y en especial de la isquemia cerebral, se centra en la monitorización simultánea de diversas variables encefálicas y sistémicas. En el momento actual, la monitorización continua de la presión intracraneal (PIC) se considera una medida indispensable en el manejo de los pacientes con un TCE grave que presentan cualquier tipo de lesión intracraneal. Sin embargo, la información que ofrece esta variable es insuficiente para diagnosticar los complejos procesos fisiopatológicos que caracterizan a las lesiones neurotraumáticas. Por ello, cada vez es más frecuente complementar la neuromonitorización de los pacientes con un TCE con métodos de estimación del flujo sanguíneo cerebral (FSC) como el Doppler transcraneal o las técnicas de oximetría yugular. Sin embargo, en el momento actual y en la cabecera del paciente, el conocimiento de la repercusión de las lesiones tisulares y de las medidas terapéuticas sobre el metabolismo cerebral requiere un acceso directo al parénquima encefálico. En esta revisión nos centraremos en tres métodos de monitorización cerebral “regional”: la presión tisular de oxígeno, la microdiálisis cerebral y las técnicas transcutáneas de espectroscopía por infrarrojos. En cada caso se expondrán los fundamentos del método en cuestión, los valores de referencia de los parámetros monitorizados y una serie de recomendaciones sobre cómo pueden interpretarse sus resultados a la luz de los conocimientos actuales.

Palabras clave:
Traumatismos craneoencefálicos
Metabolismo cerebral
Oxigenación tisular
Microdiálisis
Espectroscopía por infrarrojos
Abreviaturas:
CEO2
FSC
Hb
LCR
O2
PaO2
PaCO2
PIC
PPC
PtiO2
SjO2
SPECT
TC
TCDB
TCE
UCI
Summary

The long term outcome of head-injured patients depends not only on the primary brain lesions but also to a large extent on the secondary lesions. The diagnosis of many secondary lesions, and specially that of brain ischemia, is based on simultaneous monitoring of several intracranial and systemic variables. Continuous intracranial pressure (ICP) monitoring is currently considered indispensable in the management of all patients with a severe head injury and intracranial lesions. However, the information provided by this technique is insufficient to diagnose some of the complex physiopathological processes that characterize traumatic brain lesions. Consequently, the use of methods to estimate cerebral blood flow such as transcranial Doppler and jugular oximetry to complement ICP monitoring is becoming increasingly widespread. Nevertheless, determining the effect of tissue lesions and therapeutic measures on cerebral metabolism currently requires direct access to the brain parenchyma at the bedside. In this review we focus on three methods of regional cerebral monitoring: oxygen tissue pressure (PtiO2) monitoring, microdialysis and near-infrared spectroscopy. The bases of each method and reference values for the variables analyzed will be discussed. We also make a series of recommendations on how results should be interpreted in light of current knowledge.

Key words:
Head injury
Brain metabolism
Tissular oxygenation
Microdialysis
Near-infrared spectroscopy

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