Reactividad vascular cerebral al CO2 en la fase aguda de los traumatismos craneoencefálicos severos. Estudio preliminar de 20 casos
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García-March, M.<span class="elsevierStyleSup">a</span>J. Sánchez-Ledesma, J. Anaya, J.M. Gonçalves, J. Broseta" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "García-March" ] 1 => array:2 [ "nombre" => "M.<span class="elsevierStyleSup">a</span>J." "apellidos" => "Sánchez-Ledesma" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Anaya" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Gonçalves" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Broseta" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147390711852?idApp=UINPBA00004B" "url" => "/11301473/0000000100000005/v1_201305151000/S1130147390711852/v1_201305151000/es/main.assets" ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Reactividad vascular cerebral al CO<span class="elsevierStyleInf">2</span> en la fase aguda de los traumatismos craneoencefálicos severos. Estudio preliminar de 20 casos" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "261" "paginaFinal" => "268" ] ] "autores" => array:2 [ 0 => array:3 [ "autoresLista" => "J. Sahuquillo, C. Castaño, J. Vilalta, E. Rubio, A. Bermejo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Sahuquillo" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Castaño" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Vilalta" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Rubio" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Bermejo" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía. Ciudad Sanitaria Vall d'Hebron. Barcelona" ] ] ] 1 => array:3 [ "autoresLista" => "A. Robles, M. Baguena, R. Monforte" "autores" => array:3 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Robles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Baguena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Monforte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Vigilancia Intensiva. Hospital de Traumatología y Rehabilitación. Ciudad Sanitaria Vall d'Hebron. Barcelona" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec156558" "palabras" => array:6 [ 0 => "Traumatismo craneoencefálico" 1 => "Reactividad vascular" 2 => "Pronóstico" 3 => "Hemodinámica cerebral" 4 => "Autoregulación" 5 => "Hiperventilación" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec156557" "palabras" => array:6 [ 0 => "Head injury" 1 => "Vascular reactivity" 2 => "Outcome" 3 => "Cerebral hemodinamic" 4 => "Autoregulation" 5 => "Hyperventilation" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presentamos el estudio preliminar de 20 pacientes con un traumatismo craneoencefálico severo (TCES) en los cuales se estudió la reactividad vascular cerebral a los cambios en la presión parcial de anhídrido carbónico (pCO<span class="elsevierStyleInf">2</span>). Los criterios de entrada en el protocolo de estudio fueron los siguientes: 1) Tiempo accidente-ingreso inferior o igual a 24 horas, 2) Monitorización continua de la presión intracraneal, 3) Ausencia de lesiones toraco-pulmonares significativas y 4) Estabilidad hemodinámica en el momento de practicar los tests de vasoreactividad. En todos los casos se valoró la respuesta de la presión intracraneal media a los cambios de pCO<span class="elsevierStyleInf">2</span> arterial inducidos por modificaciones en el volumen corriente y/o frecuencia del respirador. A partir de la respuesta obtenida se calculó el índice de reactividad vascular cerebral a la hiperventilación (IRVCHR) dentro de las primeras 24 y 48 horas después del accidente.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Consideramos la respuesta a los cambios de pCO<span class="elsevierStyleInf">2</span> como abolida cuando el IRVCHR fue inferior o igual a 0.10<span class="elsevierStyleHsp" style=""></span>mmHg/mmHg pCO<span class="elsevierStyleInf">2</span> (5 casos). Los pacientes con un IRVCHR mayor de 0.10 y menor de 1<span class="elsevierStyleHsp" style=""></span>mmHg/mmHg pCO<span class="elsevierStyleInf">2</span>, se consideraron como hiporeactivos (6 casos). Valores superiores o iguales a 1<span class="elsevierStyleHsp" style=""></span>mmHg/mmHg pCO<span class="elsevierStyleInf">2</span> fueron considerados como normales (9 pacientes). Todos los casos con una abolición de la vasoreactividad a la pCO<span class="elsevierStyleInf">2</span>, presentaban a su ingreso respuestas motoras anormales, una obliteración de las cisternas de la base y del III ventrículo en la tomografía computada y tuvieron un mal resultado. En los pacientes con una respuesta preservada a la hiperventilación el IRVCHR fue de 1.32<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.01 dentro dé las primeras 24 horas después del traumatismo. En el mismo grupo, el IRVCHR aumentó a 2.39<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.43 durante segundo día (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05). Nuestros resultados sugieren una hiporeactividad relativa a los cambios de pCO<span class="elsevierStyleInf">2</span> durante las primeras 24 horas después del traumatismo. Se discuten los resultados y la utilidad que el IRVCHR puede tener en el manejo terapéutico de los pacientes con un TCES.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We report a preliminary study on 20 severe head injury patients admitted to our hospital, in whom cerebrovascular reactivity to arterial CO<span class="elsevierStyleInf">2</span> was evaluated. Entry criteria were the following: 1) time from accident to admission less than 24 hours, 2) continuous intracranial pressure monitoring, 3) no significant thoracic or lung lesions, 4) hemodynamic stability at the moment of study. In each patient, we evaluated CO<span class="elsevierStyleInf">2</span> reactivity by measuring the changes in mean intracranial pressure (ICP) that followed when manipulating the ventilator setting to reduce the arterial pCO<span class="elsevierStyleInf">2</span>. The cerebrovascular reactivity index to hyperventilation (CVRIHR) was determined by measuring the change in mean ICP per mmHg change in pCO<span class="elsevierStyleInf">2</span>. These tests, were done at 24 hour intervals during the first 48 hours after the accident. We considered that the CO<span class="elsevierStyleInf">2</span> reactivity was abolished when CVRIHR was inferior or equal to 0.10<span class="elsevierStyleHsp" style=""></span>mmHg/mmHg pCO<span class="elsevierStyleInf">2</span> (5 cases). Patients with a measured CVRIHR above 0.10 and below 1 were considered as hyporeactive (6 cases). A CVRIHR above or equal to 1 was evaluated as normal CO<span class="elsevierStyleInf">2</span> reactivity (9 patients). All the patients with abolition of CO<span class="elsevierStyleInf">2</span> reactivity had abnormal motor responses on admission, obliterated basal cisterns and third ventricle in the CT scan and all had a fatal outcome. In all patients with preservation of CO<span class="elsevierStyleInf">2</span> reactivity, CVRIHR was 1.32<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.01 in the first 24 hours after the accident. In the same group, CVRIHR increased to 2.39<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.43 when measured over the next 48 hours (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Our study suggests that CO<span class="elsevierStyleInf">2</span> responsivity is markedly impaired during the first 24 hours after the impact. We discuss our results and the importance that measuring CO<span class="elsevierStyleInf">2</span> reactivity could have in the management of severely head injured patients.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Sahuquillo, J.; Castaño, c.; Vilalta, J.; Robles, A.; Baguena, M.; Monforte, R.; Rubio, E.; Bermejo, A.: Reactividad vascular cerebral al COz en la fase aguda de los traumatismos craneoencefálicos severos. Estudio preliminar de 20 casos. Neurocirugía 1990; 1: 261–268.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
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| 2017 Mayo | 32 | 23 | 55 |
| 2017 Abril | 15 | 14 | 29 |
| 2017 Marzo | 19 | 38 | 57 |
| 2017 Febrero | 12 | 30 | 42 |
| 2017 Enero | 16 | 11 | 27 |
| 2016 Diciembre | 62 | 14 | 76 |
| 2016 Noviembre | 66 | 31 | 97 |
| 2016 Octubre | 95 | 28 | 123 |
| 2016 Septiembre | 73 | 34 | 107 |
| 2016 Agosto | 85 | 26 | 111 |
| 2016 Julio | 48 | 25 | 73 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Julio | 1 | 0 | 1 |
| 2015 Junio | 11 | 20 | 31 |
| 2015 Mayo | 32 | 23 | 55 |
| 2015 Abril | 11 | 27 | 38 |
| 2015 Marzo | 14 | 25 | 39 |
| 2015 Febrero | 13 | 30 | 43 |
| 2015 Enero | 13 | 18 | 31 |
| 2014 Diciembre | 15 | 22 | 37 |
| 2014 Noviembre | 22 | 27 | 49 |
| 2014 Octubre | 15 | 27 | 42 |
| 2014 Septiembre | 14 | 32 | 46 |
| 2014 Agosto | 21 | 39 | 60 |
| 2014 Julio | 10 | 29 | 39 |
| 2014 Junio | 17 | 27 | 44 |
| 2014 Mayo | 9 | 24 | 33 |
| 2014 Abril | 8 | 30 | 38 |
| 2014 Marzo | 12 | 23 | 35 |
| 2014 Febrero | 13 | 24 | 37 |
| 2014 Enero | 13 | 19 | 32 |
| 2013 Diciembre | 10 | 23 | 33 |
| 2013 Noviembre | 12 | 19 | 31 |
| 2013 Octubre | 20 | 28 | 48 |
| 2013 Septiembre | 22 | 32 | 54 |
| 2013 Agosto | 20 | 38 | 58 |
| 2013 Julio | 20 | 43 | 63 |
| 2013 Junio | 17 | 24 | 41 |
| 2013 Mayo | 16 | 32 | 48 |
| 2013 Abril | 12 | 27 | 39 |
| 2013 Marzo | 15 | 21 | 36 |
| 2013 Febrero | 10 | 36 | 46 |
| 2013 Enero | 16 | 18 | 34 |
| 2012 Diciembre | 11 | 12 | 23 |
| 2012 Noviembre | 1 | 7 | 8 |
| 2012 Octubre | 0 | 8 | 8 |
| 2012 Septiembre | 0 | 2 | 2 |
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