Métodos globales de monitorización de la hemodinámica cerebral en el paciente neurocrítico: fundamentos, controversias y actualizaciones en las técnicas de oximetría yugular

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Poza" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Poza" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014730570395X?idApp=UINPBA00004B" "url" => "/11301473/0000001600000004/v1_201305151241/S113014730570395X/v1_201305151241/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "titulo" => "Métodos globales de monitorización de la hemodinámica cerebral en el paciente neurocrítico: fundamentos, controversias y actualizaciones en las técnicas de oximetría yugular" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "301" "paginaFinal" => "322" ] ] "autores" => array:2 [ 0 => array:3 [ "autoresLista" => "A. Vilalta" "autores" => array:1 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Vilalta" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Investigación de Neurotraumatología. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona" ] ] ] 1 => array:4 [ "autoresLista" => "M.A. Poca, J. Sahuquillo, R. Monforte" "autores" => array:3 [ 0 => array:3 [ "nombre" => "M.A." "apellidos" => "Poca" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Sahuquillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Monforte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "**" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurocirugía. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona" "etiqueta" => "*" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos de Neurotraumatología. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona" "etiqueta" => "**" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Servicio de Neurocirugía Hospital Universitario Vall d’Hebron. Paseo Vall d’Hebron 119-129. 08035, Barcelona." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Global systems for monitoring cerebral hemodynamics in the neurocritical patient: basic concepts, controversies and recent advances in measuring jugular bulb oxygenation" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-01-20" "fechaAceptado" => "2005-02-09" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec158942" "palabras" => array:6 [ 0 => "Traumatismos craneoencefálicos" 1 => "Flujo sanguíneo cerebral" 2 => "Oximetría yugular" 3 => "AVDO2" 4 => "AVDL" 5 => "LOI" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec158943" "palabras" => array:26 [ 0 => "AVDL" 1 => "AVDO2" 2 => "CEO2" 3 => "CO2" 4 => "CMRO2" 5 => "FiO2" 6 => "FSC" 7 => "Hb" 8 => "HSA" 9 => "LCR" 10 => "LOI" 11 => "NO2" 12 => "O2" 13 => "PaCO2" 14 => "PaO2" 15 => "PAM" 16 => "PIC" 17 => "PPC" 18 => "PtiO2" 19 => "SjO2" 20 => "SPECT" 21 => "TC" 22 => "TCDB" 23 => "TCE" 24 => "TCEG" 25 => "UCI" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec158941" "palabras" => array:6 [ 0 => "Head injury" 1 => "Cerebral blood flow" 2 => "Jugular oximetry" 3 => "AVDO2" 4 => "AVDL" 5 => "LOI" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El papel relevante que la hipoxia tisular cerebral juega en la fisiopatología de los pacientes con un traumatismo craneoencefálico (TCE) justifica la necesidad de complementar la monitorización de estos pacientes con sistemas que aporten información sobre el flujo sanguíneo y el metabolismo cerebral. En la búsqueda de sistemas útiles en la cabecera del paciente, se han utilizado extrapolaciones del principio de Fick al encéfalo, utilizando métodos que estiman el flujo sanguíneo cerebral (FSC) a partir de la obtención de muestras de sangre del bulbo de la yugular. En los últimos años, las técnicas de oximetría yugular se han convertido en elementos de uso frecuente en las unidades que tratan pacientes con un TCE u otros pacientes neurocríticos, como los pacientes con una hemorragia subaracnoidea o con infartos masivos de la arteria cerebral media. El uso frecuente de estas técnicas en las últimas dos décadas, junto a la incorporación de otros sistemas de neuromonitorización, permiten en la actualidad matizar la información que estos métodos globales proporcionan y definir mejor tanto sus indicaciones como sus limitaciones. El objetivo de esta revisión es presentar los fundamentos y los conceptos básicos relacionados con la utilización clínica de las técnicas de oximetría yugular en el paciente neurocrítico. También presentamos y discutimos la evidencia más reciente que indica que determinadas variables, obtenidas de muestras de sangre del bulbo de la yugular, tales como las diferencias arterio-yugulares de lactatos (AVDL) y el índice lactato-oxígeno (LOI), a pesar de su amplia utilización en la práctica clínica diaria, no ofrecen una información fiable sobre el metabolismo cerebral que permita la toma de decisiones terapéuticas." ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "Because of the importance of hypoxic/ischemic phenomena in head-injured patients, brain monitoring in these patients should be complemented by systems providing information on cerebral blood flow and metabolism. Indirect estimations of cerebral blood flow have been obtained from blood extracted from the jugular bulb, as a special bedside application of the Fick's principle to the brain. In the last few years, the use of jugular oximetry techniques has become routine in centers treating head-injured and other neurocritical patients such as those presenting subarachnoid hemorrhage or malignant middle cerebral artery infarction. The experience acquired in the use of these techniques, as well as the introduction of new neuromonitoring systems, have deepened our understanding of the information gained and have enabled more precise definition of their indications and limitations. This review describes the basic concepts underlying the use of jugular oximetry techniques in the neurocritical patient. We also explain the reasons why several variables derived from jugular blood such as arterio-jugular differences of lactate (AVDL) or the lactate-oxygen index (LOI) do not provide accurate information on brain metabolism." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Poca, M.A.; Sahuquillo, J.; Monforte, R.; Vilalta, A.: Métodos globales de monitorización de la hemodinámica cerebral en el paciente neurocrítico: fundamentos, controversias y actualizaciones en las técnicas de oximetría yugular. Neurocirugía 2005; 16: 301–322." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:146 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Global systems for monitoring cerebral hemodynamics in the neurocritical patient: basic concepts, controversies and recent advances in measuring jugular bulb oxygenation

A. Vilalta

Unidad de Investigación de Neurotraumatología. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona

M.A. Poca*,

, J. Sahuquillo*, R. Monforte**

* Servicio de Neurocirugía. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona

** Unidad de Cuidados Intensivos de Neurotraumatología. Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona

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        "titulo" => "Global systems for monitoring cerebral hemodynamics in the neurocritical patient&#58; basic concepts&#44; controversies and recent advances in measuring jugular bulb oxygenation"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El papel relevante que la hipoxia tisular cerebral juega en la fisiopatolog&#237;a de los pacientes con un traumatismo craneoencef&#225;lico &#40;TCE&#41; justifica la necesidad de complementar la monitorizaci&#243;n de estos pacientes con sistemas que aporten informaci&#243;n sobre el flujo sangu&#237;neo y el metabolismo cerebral&#46; En la b&#250;squeda de sistemas &#250;tiles en la cabecera del paciente&#44; se han utilizado extrapolaciones del principio de Fick al enc&#233;falo&#44; utilizando m&#233;todos que estiman el flujo sangu&#237;neo cerebral &#40;FSC&#41; a partir de la obtenci&#243;n de muestras de sangre del bulbo de la yugular&#46; En los &#250;ltimos a&#241;os&#44; las t&#233;cnicas de oximetr&#237;a yugular se han convertido en elementos de uso frecuente en las unidades que tratan pacientes con un TCE u otros pacientes neurocr&#237;ticos&#44; como los pacientes con una hemorragia subaracnoidea o con infartos masivos de la arteria cerebral media&#46; El uso frecuente de estas t&#233;cnicas en las &#250;ltimas dos d&#233;cadas&#44; junto a la incorporaci&#243;n de otros sistemas de neuromonitorizaci&#243;n&#44; permiten en la actualidad matizar la informaci&#243;n que estos m&#233;todos globales proporcionan y definir mejor tanto sus indicaciones como sus limitaciones&#46; El objetivo de esta revisi&#243;n es presentar los fundamentos y los conceptos b&#225;sicos relacionados con la utilizaci&#243;n cl&#237;nica de las t&#233;cnicas de oximetr&#237;a yugular en el paciente neurocr&#237;tico&#46; Tambi&#233;n presentamos y discutimos la evidencia m&#225;s reciente que indica que determinadas variables&#44; obtenidas de muestras de sangre del bulbo de la yugular&#44; tales como las diferencias arterio-yugulares de lactatos &#40;AVDL&#41; y el &#237;ndice lactato-ox&#237;geno &#40;LOI&#41;&#44; a pesar de su amplia utilizaci&#243;n en la pr&#225;ctica cl&#237;nica diaria&#44; no ofrecen una informaci&#243;n fiable sobre el metabolismo cerebral que permita la toma de decisiones terap&#233;uticas&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Because of the importance of hypoxic&#47;ischemic phenomena in head-injured patients&#44; brain monitoring in these patients should be complemented by systems providing information on cerebral blood flow and metabolism&#46; Indirect estimations of cerebral blood flow have been obtained from blood extracted from the jugular bulb&#44; as a special bedside application of the Fick&#39;s principle to the brain&#46; In the last few years&#44; the use of jugular oximetry techniques has become routine in centers treating head-injured and other neurocritical patients such as those presenting subarachnoid hemorrhage or malignant middle cerebral artery infarction&#46; The experience acquired in the use of these techniques&#44; as well as the introduction of new neuromonitoring systems&#44; have deepened our understanding of the information gained and have enabled more precise definition of their indications and limitations&#46; This review describes the basic concepts underlying the use of jugular oximetry techniques in the neurocritical patient&#46; We also explain the reasons why several variables derived from jugular blood such as arterio-jugular differences of lactate &#40;AVDL&#41; or the lactate-oxygen index &#40;LOI&#41; do not provide accurate information on brain metabolism&#46;</p>"
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Información del artículo

ISSN: 11301473
Idioma original: Español

DOI:10.1016/S1130-1473(05)70396-1

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