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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparar la eficacia del pentobarbital y tiopental en el control de la hipertensi&#243;n intracraneal &#40;HIC&#41; refractaria a las medidas de primer nivel&#44; seg&#250;n las Gu&#237;as de Pr&#225;ctica Cl&#237;nica de la &#8220;Brain Trauma Foundation&#8221;&#44; en pacientes con traumatismo craneoencef&#225;lico &#40;TCE&#41; grave&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de cohorte&#44; aleatorizado&#44; de intervenci&#243;n terap&#233;utica comparativa entre dos f&#225;rmacos&#58; pentobarbital y tiopental&#46; La muestra fue seleccionada a partir de los pacientes que sufrieron un TCE grave &#40;Glasgow Coma Scale GCS&#44; postresucitaci&#243;n&#44; &#8804;8 puntos o deterioro neurol&#243;gico en la primera semana post traumatismo&#41; y que presentaron HIC &#40;PIC &#62;20<span class="elsevierStyleHsp" style=""></span>mmHg&#41; refractaria al tratamiento convencional&#44; de acuerdo con las Gu&#237;as de Pr&#225;ctica Cl&#237;nica de la &#8220;Brain Trauma Foundation&#8221;&#46; Adem&#225;s de comprobar la eficacia en el control de la PIC&#44; tambi&#233;n se recogieron los efectos secundarios del tratamiento&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se presentan los resultados de los primeros 20 pacientes reclutados&#44; de los cuales diez recibieron tiopental y diez pentobarbital&#46; No hubo diferencias estad&#237;sticamente significativas en las caracter&#237;sticas b&#225;sales de los pacientes &#40;edad&#44; sexo&#44; &#237;ndices de gravedad y comorbilidades&#41;&#46; Tampoco hubo diferencias respecto al GCS de ingreso &#40;tiopental seis puntos&#59; pentobarbital siete puntos&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;26&#41; ni en la tomograf&#237;a craneal computarizada de ingreso&#44; seg&#250;n la clasificaci&#243;n del &#8220;Traumatic Coma Data Bank&#8221;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En el grupo de tiopental se control&#243; la PIC en cinco casos y en el grupo de pentobarbital en dos pacientes &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;16&#41;&#46; Cinco pacientes tratados con tiopental fallecieron y ocho en el grupo de pentobarbital &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;16&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">No hubo diferencias significativas entre ambos grupos respecto a la incidencia de hipotensi&#243;n arterial &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>l&#41; o complicaciones infecciosas&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">los resultados preliminares de este estudio indican que el tiopental podr&#237;a ser m&#225;s eficaz que el pentobarbital en el control de la HIC refractaria a las medidas de primer nivel&#46; Dichos resultados confirman la evidencia experimental que indica que los mecanismos neuroprotectores de ambos f&#225;rmacos son distintos y justifican el continuar aumentando el tama&#241;o muestral de nuestro estudio para poder definir mejor la eficacia de ambos f&#225;rmacos&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To assess the effectiveness of pentobarbital and thiopental to control raised intracranial pres-sure &#40;ICP&#41;&#44; refractory to first level measures&#44; in patients with severe traumatic brain injury&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Prospective&#44; randomized study to compare the effectiveness between two treat-ments&#58; pentobarbital and thiopental&#46; The patients will be selected from those admitted to the Intensive Care Unit with a severe traumatic brain injury &#40;postresusci-tation Glasgow Coma Scale equal or less than 8 points&#41; and raised ICP &#40;ICP&#62;20<span class="elsevierStyleHsp" style=""></span>mmHg&#41; refractory to first level measures according to the Brain Trauma Foundation guidelines&#46; The adverse effeets of both treatments were also collected&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We present the results of the first 20 patients included&#46; Ten received pentobarbital and the other ten thiopental&#46; There were no statistically significance differences in patients&#8217;characteristics &#40;age&#44; sex&#44; severity of the trauma at admission and comorbilities&#41;&#46; There were no differences between both groups neither in the Glasgow Coma Scale at admission &#40;thiopental six points&#59; pentobarbital seven points&#59; P&#61;0&#44;26&#41; &#241;or in the admission Cranial Tomography&#44; according to the Trau-matic Coma Data Bank classi&#241;cation&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Thiopental treatment controlled raised ICP in flve cases and pentobarbital in two cases &#40;P&#61;0&#44;16&#41;&#46; Five patients in the thiopental group died and eight in the pentobarbital group &#40;P&#61;0&#44;16&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">There were no statistically differences between both groups regarding to the presence of hypotension &#40;P&#61;l&#41; or infectious complications&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Conclusions&#46; These preliminary results ind&#237;cate that thiopental could be more effective than pentobarbital in patients with refractory intracranial hypertension&#46; These results support previous experimental &#241;ndings that show that both treatments are not equal and justify to continu&#233; this study&#46;</p>"
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Vol. 16. Núm. 1.
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Vol. 16. Núm. 1.
Páginas 5-12 (enero 2004)
Comparación de la eficacia del pentobarbital y el tiopental en el control de la hipertensión intracraneal refractaria. Resultados preliminares en una serie de 20 pacientes
Comparison of the effectiveness of pentobarbital and thiopental in patients with refractory intracranial hypertension. Preliminary report of 20 patients
Visitas
2733
J. Pérez-Bárcena
, J. Homar, J.M. Abadal, J. Ibáñez
Servicio de Medicina Intensiva. Hospital Son Dureta. Palma Mallorca. Departament de Cirurgia. Universitat Autónoma. Barcelona
Departament de Cirurgia. Universitat Autónoma. Barcelona
B. Barceló*, F.J. Molina**, A. de la Peña***, J. Sahuquillo****
* Servicios de Análisis Clínicos. Hospital Son Dureta. Palma Mallorca
** Servicios de de Neurología. Hospital Son Dureta. Palma Mallorca
*** Servicio de Medicina Interna. Hospital Son LLatzer. Palma Mallorca
**** Servicio de Neurocirugía. Hospital Valí d’Hebrón. Barcelona
Este artículo ha recibido
Información del artículo
Resumen
Objetivo

Comparar la eficacia del pentobarbital y tiopental en el control de la hipertensión intracraneal (HIC) refractaria a las medidas de primer nivel, según las Guías de Práctica Clínica de la “Brain Trauma Foundation”, en pacientes con traumatismo craneoencefálico (TCE) grave.

Material y métodos

Estudio prospectivo de cohorte, aleatorizado, de intervención terapéutica comparativa entre dos fármacos: pentobarbital y tiopental. La muestra fue seleccionada a partir de los pacientes que sufrieron un TCE grave (Glasgow Coma Scale GCS, postresucitación, ≤8 puntos o deterioro neurológico en la primera semana post traumatismo) y que presentaron HIC (PIC >20mmHg) refractaria al tratamiento convencional, de acuerdo con las Guías de Práctica Clínica de la “Brain Trauma Foundation”. Además de comprobar la eficacia en el control de la PIC, también se recogieron los efectos secundarios del tratamiento.

Resultados

Se presentan los resultados de los primeros 20 pacientes reclutados, de los cuales diez recibieron tiopental y diez pentobarbital. No hubo diferencias estadísticamente significativas en las características básales de los pacientes (edad, sexo, índices de gravedad y comorbilidades). Tampoco hubo diferencias respecto al GCS de ingreso (tiopental seis puntos; pentobarbital siete puntos; P=0,26) ni en la tomografía craneal computarizada de ingreso, según la clasificación del “Traumatic Coma Data Bank”.

En el grupo de tiopental se controló la PIC en cinco casos y en el grupo de pentobarbital en dos pacientes (P=0,16). Cinco pacientes tratados con tiopental fallecieron y ocho en el grupo de pentobarbital (P=0,16).

No hubo diferencias significativas entre ambos grupos respecto a la incidencia de hipotensión arterial (P=l) o complicaciones infecciosas.

Conclusiones

los resultados preliminares de este estudio indican que el tiopental podría ser más eficaz que el pentobarbital en el control de la HIC refractaria a las medidas de primer nivel. Dichos resultados confirman la evidencia experimental que indica que los mecanismos neuroprotectores de ambos fármacos son distintos y justifican el continuar aumentando el tamaño muestral de nuestro estudio para poder definir mejor la eficacia de ambos fármacos.

Palabras clave:
Traumatismo craneal
Hipertensión intracraneal
Pentobarbital
Tiopental
Abreviaturas:
APACHE
FSC
GCS
HIC
ISS
LCR
PIC
SAPS
SNC
TAM
TC
TCE
VSC
Objective

To assess the effectiveness of pentobarbital and thiopental to control raised intracranial pres-sure (ICP), refractory to first level measures, in patients with severe traumatic brain injury.

Material and methods

Prospective, randomized study to compare the effectiveness between two treat-ments: pentobarbital and thiopental. The patients will be selected from those admitted to the Intensive Care Unit with a severe traumatic brain injury (postresusci-tation Glasgow Coma Scale equal or less than 8 points) and raised ICP (ICP>20mmHg) refractory to first level measures according to the Brain Trauma Foundation guidelines. The adverse effeets of both treatments were also collected.

Results

We present the results of the first 20 patients included. Ten received pentobarbital and the other ten thiopental. There were no statistically significance differences in patients’characteristics (age, sex, severity of the trauma at admission and comorbilities). There were no differences between both groups neither in the Glasgow Coma Scale at admission (thiopental six points; pentobarbital seven points; P=0,26) ñor in the admission Cranial Tomography, according to the Trau-matic Coma Data Bank classiñcation.

Thiopental treatment controlled raised ICP in flve cases and pentobarbital in two cases (P=0,16). Five patients in the thiopental group died and eight in the pentobarbital group (P=0,16).

There were no statistically differences between both groups regarding to the presence of hypotension (P=l) or infectious complications.

Conclusions. These preliminary results indícate that thiopental could be more effective than pentobarbital in patients with refractory intracranial hypertension. These results support previous experimental ñndings that show that both treatments are not equal and justify to continué this study.

Key word:
Head injury
Intracranial hypertension
Pentobarbital
Thiopental

Artículo

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Herramientas
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?