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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los fundamentos te&#243;ricos para el tratamiento de los pacientes con un traumatismo craneoencef&#225;lico &#40;TCE&#41; grave se derivan del concepto de lesi&#243;n secundaria&#46; En este trabajo actualizamos las pautas de tratamiento seguidas en el traumatismo craneoencef&#225;lico y de aquel subgrupo de pacientes que presentan hipertensi&#243;n intracraneaI&#46; Introducimos el nuevo paradigma denominado medicina basada en la evidencia haciendo &#233;nfasis en sus implicaciones presentes y futuras en el tratamiento de los traumatismos craneoencef&#225;licoso Presentamos una revisi&#243;n de las recomendaciones sugeridas por las Gu&#237;as de pr&#225;ctica cl&#237;nica recientemente publicadas bajo los auspicios de la Brain Trauma Foundation&#46; En este art&#237;culo revisamos tambi&#233;n los grupos espec&#237;ficos de drogas utilizados en el tratamiento de estos pacientes y que incluyen entre otras&#58; Sedantes y analg&#233;sicos&#44; bloqueantes musculares&#44; barbit&#250;ricos&#44; corticosteroides y soluciones hiperosmolares&#46; Planteamos las controversias existentes en el uso de algunos tratamientos tales como el aumento de la presi&#243;n de perfusi&#243;n cerebral mediante drogas vasoactivas&#44; la hiperventilaci&#243;n o el uso de drogas tales como la dihidroergotamina y la indometacina&#46; Tambi&#233;n presentamos una revisi&#243;n hist&#243;rica y las controversias existentes sobre el uso de corticosteroides y se discuten los fundamentos y la potencial utilidad de ciertas drogas dirigidas a bloquear las cascadas neuroqu&#237;micas an&#243;malas que se han demostrado en estos pacientes&#46; Presentamos y discutimos tambi&#233;n las bases te&#243;ricas sobre la utilizaci&#243;n de los 21-aminoesteroides &#40;Lazaroides&#41;&#44; los antagonistas del calcio&#44; algunos f&#225;rmacos potenciales protectores de membrana y los inhibidores del glutamato en el tratamiento de estos pacientes&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The theoretical basis for treatment of severe head injury derives from the concept of secondary damage to the brain&#46; This paper provides an overview of the current therapeutic approaches used in treating severe head injury and in particular those patients who develop high intracranial pressure&#46; Special emphasis is given to the new paradigm of so-called evidence-based medicine and its influence on the present and future management of severe head injuries&#46; A review of the recommendations suggested by the <span class="elsevierStyleItalic">Guidelines for the Treatment of Severe Head Injury</span>&#44; recently published by the Brain Trauma Foundation are presented&#46; Specific types of drugs covered in this review include sedatives&#44; analgesics&#44; paralytic agents&#44; barbiturates&#44; steroids and hyperosmolar solutions&#46; The controversies surrounding certain treatments such as the increase of cerebral perfusion pressure with vasoactive drugs&#44; hyperventilation&#44; indomethacine or dihydroergotamine are outlined&#46; We also review the historical background and the controversies over the use of steroids in these patients&#46; The recentiy developed drugs capable of blocking the damaging neurochemical cascades identified in severe head injury are discussed&#46; Finally&#44; the rationale for using 21-aminosteroids &#40;Lazaroids&#41;&#44; calcium-antagonists&#44; potential membrane-protectors and the different types of glutamate receptors is also presented&#46;</p>"
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Vol. 10. Núm. 3.
Páginas 185-209 (enero 1998)
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Vol. 10. Núm. 3.
Páginas 185-209 (enero 1998)
Avances en el tratamiento de los traumatismos craneoencefálicos graves
Advances in the management of severe head injury
Visitas
4708
J. Sahuquillo, M.A. Poca, E. Rubio
Servicio de Neurocirugía, Hospitales Universitarios Vall d’Hebron. Barcelona
F. Munar*
* Unidad de Neurotraumatología, Hospitales Universitarios Vall d’Hebron. Barcelona
Este artículo ha recibido
Información del artículo
Resumen

Los fundamentos teóricos para el tratamiento de los pacientes con un traumatismo craneoencefálico (TCE) grave se derivan del concepto de lesión secundaria. En este trabajo actualizamos las pautas de tratamiento seguidas en el traumatismo craneoencefálico y de aquel subgrupo de pacientes que presentan hipertensión intracraneaI. Introducimos el nuevo paradigma denominado medicina basada en la evidencia haciendo énfasis en sus implicaciones presentes y futuras en el tratamiento de los traumatismos craneoencefálicoso Presentamos una revisión de las recomendaciones sugeridas por las Guías de práctica clínica recientemente publicadas bajo los auspicios de la Brain Trauma Foundation. En este artículo revisamos también los grupos específicos de drogas utilizados en el tratamiento de estos pacientes y que incluyen entre otras: Sedantes y analgésicos, bloqueantes musculares, barbitúricos, corticosteroides y soluciones hiperosmolares. Planteamos las controversias existentes en el uso de algunos tratamientos tales como el aumento de la presión de perfusión cerebral mediante drogas vasoactivas, la hiperventilación o el uso de drogas tales como la dihidroergotamina y la indometacina. También presentamos una revisión histórica y las controversias existentes sobre el uso de corticosteroides y se discuten los fundamentos y la potencial utilidad de ciertas drogas dirigidas a bloquear las cascadas neuroquímicas anómalas que se han demostrado en estos pacientes. Presentamos y discutimos también las bases teóricas sobre la utilización de los 21-aminoesteroides (Lazaroides), los antagonistas del calcio, algunos fármacos potenciales protectores de membrana y los inhibidores del glutamato en el tratamiento de estos pacientes.

Palabras clave:
Traumatismos craneoencefálicos
Revisión
Estrategias terapéuticas
Corticosteroides
Hiperventilación
Medicina basada en la evidencia
Abstract

The theoretical basis for treatment of severe head injury derives from the concept of secondary damage to the brain. This paper provides an overview of the current therapeutic approaches used in treating severe head injury and in particular those patients who develop high intracranial pressure. Special emphasis is given to the new paradigm of so-called evidence-based medicine and its influence on the present and future management of severe head injuries. A review of the recommendations suggested by the Guidelines for the Treatment of Severe Head Injury, recently published by the Brain Trauma Foundation are presented. Specific types of drugs covered in this review include sedatives, analgesics, paralytic agents, barbiturates, steroids and hyperosmolar solutions. The controversies surrounding certain treatments such as the increase of cerebral perfusion pressure with vasoactive drugs, hyperventilation, indomethacine or dihydroergotamine are outlined. We also review the historical background and the controversies over the use of steroids in these patients. The recentiy developed drugs capable of blocking the damaging neurochemical cascades identified in severe head injury are discussed. Finally, the rationale for using 21-aminosteroids (Lazaroids), calcium-antagonists, potential membrane-protectors and the different types of glutamate receptors is also presented.

Key words:
Head injury
Review
Management strategies
Steroids
Hyperventilation
Evidence-based medicine

Artículo

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