Existencia de hipoperfusión oculta sistémica en el traumatismo craneoencefálico. Estudio preliminar
Evidence of occult systemic hypoperfussion in head injured patients. Preliminary study
F. Murillo-Cabezas
, R. Amaya-Villar, Mª.D. Rincón-Ferrari, J.M. Flores-Cordero, S. García-Gómez, Mª.A. Muñoz-Sánchez
Servicio de Cuidados Críticos y Urgencias. Hospitales Universitarios Virgen del Rocío. Sevilla
J. Valencia-Anguita*
* Servicio de Neurocirugía. Hospitales Universitarios Virgen del Rocío. Sevilla
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Sevilla." ] ] ] 1 => array:3 [ "autoresLista" => "J. Valencia-Anguita" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Valencia-Anguita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Neurocirugía. Hospitales Universitarios Virgen del Rocío. Sevilla" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Evidence of occult systemic hypoperfussion in head injured patients. Preliminary study" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-09-03" "fechaAceptado" => "2004-11-29" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec158957" "palabras" => array:4 [ 0 => "Traumatismo craneoencefálico" 1 => "Acido láctico" 2 => "Hipoperfusión oculta" 3 => "Deuda de oxígeno" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec158956" "palabras" => array:15 [ 0 => "AIS" 1 => "AL" 2 => "APACHE II" 3 => "GCS" 4 => "HO" 5 => "ICU" 6 => "ISS" 7 => "LA" 8 => "OH" 9 => "RTS" 10 => "SDRA" 11 => "TAC" 12 => "TCE" 13 => "TSR" 14 => "UCI" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec158958" "palabras" => array:4 [ 0 => "Head Injury" 1 => "Lactic Acid." 2 => "Occult hypoperfussion" 3 => "Oxygen Debt" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Investigar en pacientes con traumatismo craneoencefálico grave y moderado (TCE), hemodinámicamente estables, la relación entre los valores arteriales de ácido láctico (AL) en las primeras 48 horas con la evolución y complicaciones del TCE, y conocer qué factores de riesgo se relacionan con valores anormales de AL.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional, pros-pectivo, de cohorte, de 210 pacientes adultos con TCE grave y moderado. Conseguida la estabilización hemodinámica del paciente, se realizó una determinación basal de AL, que se repitió cada 12 horas durante las primeras 48 horas y, posteriormente, cada 24 horas hasta la normalización de los valores de AL. Los pacientes se clasificaron en dos grupos: Grupo 1 (AL < 2,2<span class="elsevierStyleHsp" style=""></span>mmol/L) sin hipoperfusión oculta (HO), y grupo 2 (AL ≥ 2,2<span class="elsevierStyleHsp" style=""></span>mmol/L) con HO.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">115 pacientes (57,76%) se catalogaron como grupo 1, y 95 pacientes (45,24%) como grupo 2. En el análisis univariante de los factores de riesgo para AL ≥ 2,2<span class="elsevierStyleHsp" style=""></span>mmol/L mostraron significación estadística todos los índices generales de gravedad del TCE [Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Trauma Score Revisado (TSR) y Acute Physiology and Chronic Health Evaluation (APACHE) II], la hipotensión arterial, hipoxemia, anemia, hiper-glucemia, hipotermia y la mayor incidencia de administración de noradrenalina. Asimismo, en el grupo 1 se objetivó un mayor porcentaje en la TAC de ingreso de lesiones tipo II (53,91% vs. 38,94%) (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,03). En el análisis multivariante de regresión logística, sólo dos factores se asociaron de forma independiente a valores elevados de AL: APACHE II en las primeras 24 horas: OR 1,12 (IC 95% 1,06–1,196; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001) y volumen de líquidos total infundido en las primeras 48 horas: OR 1,09 (IC 95% 1,02–1,16; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001). El grupo 2 se asoció, con significación estadística, a una mayor tasa de infecciones (63,2% vs 47,8%, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,026), y al aumento de la estancia en UCI. [mediana (percentil 25–75)] [13,29 (7,11–21,22) días vs. 8,78 (4,40–16,72) días; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,018]. Aunque fue más alto el porcentaje de hipertensión intracraneal y mortalidad en el grupo 2, no se constató significación estadística. El aumento de AL, en el análisis multivariante, no se comportó como factor independiente de riesgo para las complicaciones estudiadas.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La existencia de HO en pacientes con TCE graves y moderados, con valores de presión arterial postreanimación según las recomendaciones actuales, se asocia a una mayor gravedad del TCE manifestada por el APACHE II y por el volumen de líquidos administrado en las primeras 48 horas. La HO en el TCE conlleva un aumento de la tasa de infecciones y de la estancia en UCI.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the correlation between blood lactic acid levels in the first48 hours and outcome, in hemodynamically stable patients, with moderate or severe head injury (HI), and to investigate the risk factors associated with abnormal lactate levels.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A prospective observational study, in 210 adults patients with moderate or severe head injury. When the patients were hemodynamically stable, blood lactate concentrations were measured once on admission, twice daily during the first 2 days and once daily until lactate levels were normalized. The whole group 210 patients were divided into 2 groups. Group 1: (LA < 2,2<span class="elsevierStyleHsp" style=""></span>mmol/L) patients without occult hypoperfussion (OH), and group 2: (LA ≥ 2,2<span class="elsevierStyleHsp" style=""></span>mmol/L) patients with OH.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">One hundred and fifteen patients (57,76%) were categorized as group 1, and 95 patients (45,24%) as group 2. In the univariate analysis of risk factors for blood lactate ≥ 2,2<span class="elsevierStyleHsp" style=""></span>mmol/L the following variables showed statistical significance: severity of the head injury measured by several scales [Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Revised Trauma Score (RTS) and Acute Physiology and Chronic Health Evaluation (APACHE) II], arterial hypotension, hypoxemia, anaemia, hyperglucemia, hypothermia, a greater incidence of norepinephrine infusion, and the higher percentage of type II lesions in the head computerized tomography at admission showed in the group 1 (53,91% vs. 38,94%) (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,03). In the multiple logistic regression analysis only two variables were risk independently associated with elevated blood lactate concentration: APACHE II in the first 24 hours: OR 1,12 (95% IC 1,06–1,196; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001) and the first 48-hours total fluid infusion volumes: OR 1,09 (95% IC 1,021,16; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001). The infection rate (63,2% vs 47,8%, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,026), and length of ICU stay [mediana (percentil 25–75)] [13,29 (7,11–21,22) days vs. 8,78 (4,40–16,72) days; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,018] were significantly higher in patients with blood lactate ≥ 2,2<span class="elsevierStyleHsp" style=""></span>mmol/L (group 2). Although, the percentage of intracranial hypertension and mortality was higher in the group 2, there was no significant difference. In the multivariate analysis, the increase of blood lactate concentration, was not independently associated as a risk factor with studied complications.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The presence of OH in patients with moderate or severe head injury, with postres uscitation arterial pressure, according to present recommendations, is associated with a more severe head injury, showed by APACHE II and the total fluid infusion volumes in the first 48 hours. OH in head injury increases the infection rate and length of ICU stay.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Murillo-Cabezas, F.; Amaya-Villar,R.; Rincón-Ferrari, Mª.D.; Flores-Cordero, J.M.; Valencia-Anguita, J.; García-Gómez, S.; Muñoz-Sánchez, Mª.A.: Existencia de hipoperfusión oculta sistémica en el traumatismo craneoencefálico. Estudio Preliminar. Neurocirugía 2005; 16: 323–332.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The Brain Trauma Foundation. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 1 | 1 | 2 |
| 2018 Febrero | 10 | 5 | 15 |
| 2018 Enero | 11 | 11 | 22 |
| 2017 Diciembre | 14 | 13 | 27 |
| 2017 Noviembre | 24 | 31 | 55 |
| 2017 Octubre | 9 | 8 | 17 |
| 2017 Septiembre | 14 | 22 | 36 |
| 2017 Agosto | 15 | 21 | 36 |
| 2017 Julio | 12 | 7 | 19 |
| 2017 Junio | 18 | 7 | 25 |
| 2017 Mayo | 17 | 8 | 25 |
| 2017 Abril | 24 | 13 | 37 |
| 2017 Marzo | 16 | 23 | 39 |
| 2017 Febrero | 7 | 4 | 11 |
| 2017 Enero | 9 | 3 | 12 |
| 2016 Diciembre | 24 | 6 | 30 |
| 2016 Noviembre | 19 | 9 | 28 |
| 2016 Octubre | 31 | 10 | 41 |
| 2016 Septiembre | 34 | 5 | 39 |
| 2016 Agosto | 46 | 19 | 65 |
| 2016 Julio | 29 | 14 | 43 |
| 2016 Junio | 1 | 0 | 1 |
| 2016 Marzo | 2 | 0 | 2 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Agosto | 1 | 0 | 1 |
| 2015 Julio | 0 | 5 | 5 |
| 2015 Junio | 12 | 4 | 16 |
| 2015 Mayo | 19 | 9 | 28 |
| 2015 Abril | 13 | 16 | 29 |
| 2015 Marzo | 15 | 12 | 27 |
| 2015 Febrero | 14 | 8 | 22 |
| 2015 Enero | 14 | 14 | 28 |
| 2014 Diciembre | 14 | 16 | 30 |
| 2014 Noviembre | 13 | 19 | 32 |
| 2014 Octubre | 19 | 16 | 35 |
| 2014 Septiembre | 16 | 16 | 32 |
| 2014 Agosto | 18 | 18 | 36 |
| 2014 Julio | 15 | 13 | 28 |
| 2014 Junio | 25 | 18 | 43 |
| 2014 Mayo | 23 | 24 | 47 |
| 2014 Abril | 19 | 14 | 33 |
| 2014 Marzo | 17 | 18 | 35 |
| 2014 Febrero | 26 | 19 | 45 |
| 2014 Enero | 22 | 19 | 41 |
| 2013 Diciembre | 17 | 22 | 39 |
| 2013 Noviembre | 16 | 16 | 32 |
| 2013 Octubre | 23 | 20 | 43 |
| 2013 Septiembre | 30 | 17 | 47 |
| 2013 Agosto | 22 | 21 | 43 |
| 2013 Julio | 30 | 28 | 58 |
| 2013 Junio | 14 | 11 | 25 |
| 2013 Mayo | 14 | 12 | 26 |
| 2013 Abril | 13 | 13 | 26 |
| 2013 Marzo | 15 | 16 | 31 |
| 2013 Febrero | 15 | 14 | 29 |
| 2013 Enero | 20 | 10 | 30 |
| 2012 Diciembre | 15 | 13 | 28 |
| 2012 Noviembre | 0 | 5 | 5 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Septiembre | 0 | 2 | 2 |
| 2012 Enero | 16 | 0 | 16 |
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