Efectos de la dexmedetomidina sobre la hemodinámica intracraneal en pacientes con lesión encefálica traumatica grave
Effects of dexmedetomidine on intracranial hemodynamics in severe head injured patients
P. Grille, A. Biestro
, G. Fariña, R. Miraballes
Unidad de Cuidados Intensivo. Hospital de Clínicas. Universidad de la República. Montevideo. Uruguays
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Miraballes" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Grille" ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Biestro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Fariña" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Miraballes" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Cuidados Intensivo. Hospital de Clínicas. Universidad de la República. Montevideo. Uruguays" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: CTI del Hospital de Clínicas, Piso 14. Universidad de la República. Avenida Italia s/n. CP 11600 Montevideo. Uruguay." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Effects of dexmedetomidine on intracranial hemodynamics in severe head injured patients" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-09-03" "fechaAceptado" => "2004-11-13" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159029" "palabras" => array:7 [ 0 => "Dexmedetomidina" 1 => "Lesión encefá-lica traumática grave" 2 => "Trauma craneal" 3 => "Presión intracraneal" 4 => "Presión de perfusión cerebral" 5 => "Hemodinámica intracraneal" 6 => "Saturación de oxígeno yugular" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec159028" "palabras" => array:16 [ 0 => "APACHE" 1 => "CEO<span class="elsevierStyleInf">2</span>" 2 => "paCO<span class="elsevierStyleInf">2</span>" 3 => "CTI" 4 => "DE" 5 => "FC" 6 => "FSC" 7 => "GCS" 8 => "HIC" 9 => "PA" 10 => "PAM" 11 => "PIC" 12 => "PPC" 13 => "SjO<span class="elsevierStyleInf">2</span>" 14 => "TCEG" 15 => "VSC" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159027" "palabras" => array:7 [ 0 => "Dexmedetomidine" 1 => "Head injury" 2 => "Head trauma" 3 => "Intracranial pressure" 4 => "Cerebral perfusion pressure" 5 => "Intracranial hemodynamics" 6 => "Oxygen jugular saturation" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La dexmedetomidina, un agonista adrenérgico selectivo α2, constituye un intento de mejorar la sedoanalgesia de los pacientes críticos, por sus efectos distintivos en comparación a los planes tradicionales como son: sedación consciente, simpaticolisis y ausencia de depresión respiratoria.</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudiar el efecto de la dexmedetomidina, un nuevo agonista α28, sobre la hemodinámica intracraneal y sobre los parámetros hemometabólicos cerebrales en un grupo de pacientes con trauma craneoencefálico grave.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de los pacientes con lesión encefálica traumática grave (Glasgow Coma Scale ≤ 8) ingresados en un Centro de Tratamiento Intensivo (CTI) que recibieron monitorización de la presión intracraneal (PIC) y monitorización de saturación de O<span class="elsevierStyleInf">2</span> del bulbo yugular (SjO<span class="elsevierStyleInf">2</span>). Se realizó una perfusión intravenosa de la droga durante 3 horas, en dosis progresivas (0.2, 0.4 y 0.7<span class="elsevierStyleHsp" style=""></span>ug/kg/h), previa suspensión de otros sedantes y analgésicos.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 12 pacientes sin hiperten-sión intracraneal. No se encontraron diferencias significativas entre los valores de PIC y presión arterial media (PAM) tras la infusión de la droga en relación con los valores basales. La presión de perfusión cerebral (PPC) mostró una tendencia a disminuir durante el estudio (efecto marginal, p=0.058). Se encontró un descenso significativo de la frecuencia cardíaca (FC) (p<0.0001) en relación a los valores basales. No se hallaron diferencias significativas en los parámetros hemometabólicos cerebrales (SjO<span class="elsevierStyleInf">2</span> y CEO<span class="elsevierStyleInf">2</span>).</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A las dosis utilizadas, la dexmede-tomidina fue segura, no asociándose a alteraciones significativas de la hemodinámica intracraneal ni del metabolismo sanguíneo cerebral en pacientes en la etapa aguda del trauma craneoencefálico grave (TECG)</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Dexmedetomidine, an α2 adrenergic agonist, with distinctive characteristics when compared to traditional plans, namely: conscious sedation, sympatholysis and lack of respiratory depression, represents an attempt to improve the sedoanalgesia of critically ill patients.</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To study dexmedetomidine's effect on intracranial hemodynamic and hemometabolic parameters in severe head injured patients.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Prospective study on the effect of Dexmedetomidine on twelve severe head injured patients (Glasgow Coma Scale score ≤ 8) admitted to an intensive care unit, with intracranial pressure < 20<span class="elsevierStyleHsp" style=""></span>mmHg and O<span class="elsevierStyleInf">2</span> saturation monitoring of blood from jugular bulb. The drug was perfused intravenously during 3 hours, in progressive doses (0.2, 0.4 y 0.7<span class="elsevierStyleHsp" style=""></span>ug/kg/h). All other sedo-analgesia medication had been previously withdrawn.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">No significant differences were found in intracranial pressure, mean arterial pressure and cerebral hemometabolic parameters after infusion of dexmedetomidine in relation to basal values. Cerebral perfusion pressure showed a trend to decrease during the drug infusion (marginal effect, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.058). Cardiac frequency decreased significantly after the drug administration.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">At the doses utilized, dexmedetomidine was safe, and it was not associated with significant changes in intracranial hemodynamics, nor in cerebral hemometabolic parameters, in a group of severe head jnjured patients.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Grille, P.; Biestro, A.; Fariña, G.; Miraballes, R.: Efectos de la dexmedetomidina sobre la hemodinámica intracraneal en pacientes con lesión encefálica traumatica grave. Neurocirugía 2005; 16: 411–418.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
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