Hay otras áreas importantes de posible conflicto que no es
posible abordar en los límites de este texto, aunque se recomienda
a los lectores que se formen en lo siguiente:
•
Los problemas que rodean a la donación de órganos de
donante con muerte cerebral y de donante con corazón que
no late.
•
La retirada de la asistencia del paciente no competente y sin
familia.
•
Los reglamentos hospitalarios y la legislación estatal sobre la
certificación de muerte, ya sea por criterios neurológicos o
cardiovasculares.
Resumen
Los cuidados neurocríticos exigen un conocimiento exhaustivo de
la fisiología, la farmacología y la patología del sistema nervioso, así
como de los órganos que le dan soporte. La mejor asistencia se
presta en circunstancias que permiten una colaboración multidis-
ciplinar y una atención adecuada al detalle de procesos patológicos
con frecuencia complejos y difíciles, aunque con la integración
óptima de los mismos bajo la dirección de un médico de cuidados
críticos.
1. Zygun D: Non-neurological organ dysfunction in
neurocritical care: Impact on outcome and etiologi-
cal considerations. Curr Opin Crit Care 11:139–143,
2005.
2. Suarez JI, Zaidat OO, Suri MF, et al: Length of stay
and mortality in neurocritically ill patients: Impact
of a specialized neurocritical care team. Crit Care
Med 32:2311–2317, 2004.
3. Maramattom BV, Bahn MM, Wijdicks EF: Which
patient fares worse after early deterioration due to
swelling from hemispheric stroke? Neurology
63:2142–2145, 2004.
4. Kalmar AF, Van AJ, Caemaert J, et al: Value of
Cushing reflex as warning sign for brain ischaemia
during neuroendoscopy. Br J Anaesth 94:791–799,
2005.
5. Klatzo I: Pathophysiological aspects of brain edema.
Acta Neuropathol (Berl) 72:236–239, 1987.
6. Jones PA, Andrews PJ, Midgley S, et al: Measuring
the burden of secondary insults in head-injured
patients during intensive care. J Neurosurg Anes-
thesiol 6:4–14, 1994.
7. Beaumont A, Hayasaki K, Marmarou A, et al: Con-
trasting effects of dopamine therapy in experimental
brain injury. J Neurotrauma 18:1359–1372, 2001.
8. Faraci FM, Heistad DD: Regulation of the cerebral
circulation: Role of endothelium and potassium
channels. Physiol Rev 78:53–97, 1998.
9. Wartenberg KE, Schmidt JM, Claassen J, et al:
Impact of medical complications on outcome after
subarachnoid hemorrhage. Crit Care Med 34:617–
623, 2006.
10. McKeating EG, Andrews PJ, Mascia L: The relation-
ship of soluble adhesion molecule concentrations in
systemic and jugular venous serum to injury seve-
rity and outcome after traumatic brain injury.
Anesth Analg 86:759–765, 1998.
11. Stocchetti N, Colombo A, Ortolano F, et al: Time
course of intracranial hypertension after traumatic
brain injury. J Neurotrauma 24:1339–1346, 2007.
12. Muench E, Bauhuf C, Roth H, et al: Effects of posi-
tive end-expiratory pressure on regional cerebral
blood flow, intracranial pressure, and brain tissue
oxygenation. Crit Care Med 33:2367–2372, 2005.
13. Manley G, Knudson MM, Morabito D, et al: Hypo-
tension, hypoxia, and head injury: Frequency, dura-
tion, and consequences. Arch Surg 136:1118–1123,
2001.
14. Chesnut RM, Marshall LF, Klauber MR, et al: The
role of secondary brain injury in determining
outcome from severe head injury. J Trauma 34:216–
222, 1993.
15. Rosner MJ, Rosner SD, Johnson AH: Cerebral per-
fusion pressure: Management protocol and clinical
results. J Neurosurg 83:949–962, 1995.
16. Pelosi P, Severgnini P, Chiaranda M: An integrated
approach to prevent and treat respiratory failure in
brain-injured patients. Curr Opin Crit Care 11:37–
42, 2005.
17. McKeating EG, Andrews PJ, Signorini DF, Mascia L:
Transcranial cytokine gradients in patients requi-
ring intensive care after acute brain injury. Br J
Anaesth 78:520–523, 1997.
18. Malham GM, Souter MJ: Systemic inflammatory
response syndrome and acute neurological disease.
Br J Neurosurg 15:381–387, 2001.
19. Mascia L, Zavala E, Bosma K, et al: High tidal
volume is associated with the development of acute
lung injury after severe brain injury: An internatio-
nal observational study. Crit Care Med 35:1815–
1820, 2007.
20. Wolf S, Schurer L, Trost HA, Lumenta CB: The
safety of the open lung approach in neurosurgical
patients. Acta Neurochir Suppl 81:99–101, 2002.
21. Diringer MN, Zazulia AR: Osmotic therapy: Fact
and fiction. Neurocrit Care 1:219–233, 2004.
22. Xiao F: Bench to bedside: Brain edema and cerebral
resuscitation: The present and future. Acad Emerg
Med 9:933–946, 2002.
23. Claydon VE, Steeves JD, Krassioukov A: Orthostatic
hypotension following spinal cord injury: Unders-
tanding clinical pathophysiology. Spinal Cord 44:
341–351, 2006.
24. Orpello JM, Benjamin E: Critical care of patients
with subarachnoid hemorrhage.
In
Bederson JB
(ed): Subarachnoid Hemorrhage: Pathophysiology
and Management. Park Ridge, IL, American
Association of Neurological Surgeons, 1997, pp
173–188.
25. Perel P, Yanagawa T, Bunn F, et al: Nutritional
support for head-injured patients. Cochrane Data-
base Syst Rev 4, CD001530, 2006.
26. Rovlias A, Kotsou S: The influence of hyperglycemia
on neurological outcome in patients with severe
head injury. Neurosurgery 46:335–342, 2000.
27. Vespa P, Boonyaputthikul R, McArthur DL, et al:
Intensive insulin therapy reduces microdialysis
glucose values without altering glucose utilization or
improving the lactate/pyruvate ratio after traumatic
brain injury. Crit Care Med 34:850–856, 2006.
28. Kilpatrick MM, Lowry DW, Firlik AD, et al: Hyper-
thermia in the neurosurgical intensive care unit.
Neurosurgery 47:850–855, 2000.
29. Gungor E, Alli N, Comoglu S, Comcuoglu C: Phen-
ytoin hypersensitivity syndrome. Neurol Sci 22:
261–265, 2001.
30. Hajat C, Hajat S, Sharma P: Effects of poststroke
pyrexia on stroke outcome: A meta-analysis of
studies in patients. Stroke 31:410–414, 2000.
31. Clifton GL, Miller ER, Choi SC, et al: Lack of effect
of induction of hypothermia after acute brain
injury. N Engl J Med 344:556–563, 2001.
32. Todd MM, Hindman BJ, Clarke WR, Torner JC:
Mild intraoperative hypothermia during surgery
for intracranial aneurysm. N Engl J Med 352:135–
145, 2005.
33. Mayer SA, Kowalski RG, Presciutti M, et al: Clinical
trial of a novel surface cooling system for fever
control in neurocritical care patients. Crit Care Med
32:2508–2515, 2004.
34. Becker DP, Miller JD, Ward JD, et al: The outcome
from severe head injury with early diagnosis and
intensive management. J Neurosurg 47:491–502,
1977.
35. Ragauskas A, Daubaris G, Dziugys A, et al: Innova-
tive non-invasive method for absolute intracranial
pressure measurement without calibration. Acta
Neurochir Suppl 95:357–361, 2005.
36. Cremer OL, van Dijk GW, vanWensen E, et al: Effect
of intracranial pressure monitoring and targeted
intensive care on functional outcome after severe
head injury. Crit Care Med 33:2207–2213, 2005.
37. Sahuquillo J, Poca MA, Arribas M, et al: Interhemis-
pheric supratentorial intracranial pressure gradients
in head-injured patients: Are they clinically impor-
tant? J Neurosurg 90:16–26, 1999.
38. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES
Jr: Ventriculostomy-related infections: A critical
review of the literature. Neurosurgery 51:170–181,
2002.
39. Piper I, Barnes A, Smith D, Dunn L: The Camino
intracranial pressure sensor: Is it optimal techno-
logy? An internal audit with a review of current
intracranial pressure monitoring technologies.
Neurosurgery 49:1158–1164, 2001.
40. Lundberg N: Continuous recording and control of
ventricular fluid pressure in neurosurgical practice.
Acta Psychiatr Scand Suppl 36:1–193, 1960.
41. Symon L, Lassen NA, Astrup J, Branston NM:
Thresholds of ischaemia in brain cortex. Adv Exp
Med Biol 94:775–782, 1977.
42. Kety SS: The measurement of cerebral blood flow
by means of inert diffusible tracers. Keio J Med
43:9–14, 1994.
43. Burger R, Vince GH, Meixensberger J, et al: Interre-
lations of laser Doppler flowmetry and brain tissue
oxygen pressure during ischemia and reperfusion
induced by an experimental mass lesion. J Neuro-
trauma 16:1149–1164, 1999.
44. Sioutos PJ, Orozco JA, Carter LP, et al: Continuous
regional cerebral cortical blood flow monitoring in
head-injured patients. Neurosurgery 36:943–949,
1995.
45. Melot C, Berre J, Moraine JJ, Kahn RJ: Estimation
of cerebral blood flow at bedside by continuous
jugular thermodilution. J Cereb Blood Flow Metab
16:1263–1270, 1996.
46. Aaslid R, Markwalder TM, Nornes H: Noninvasive
transcranial Doppler ultrasound recording of flow
velocity in basal cerebral arteries. J Neurosurg
57:769–774, 1982.
47. Stolz E, Kaps M, Kern A, Dorndorf W: Frontal bone
windows for transcranial color-coded duplex sono-
graphy. Stroke 30:814–820, 1999.
48. Aaslid R, Huber P, Nornes H: Evaluation of cerebro-
vascular spasm with transcranial Doppler ultra-
sound. J Neurosurg 60:37–41, 1984.
49. Lindegaard KF, Nornes H, Bakke SJ, et al: Cerebral
vasospasm after subarachnoid haemorrhage investi-
gated by means of transcranial Doppler ultrasound.
Acta Neurochir Suppl (Wien) 42:81–84, 1988.
50. Tiecks FP, Lam AM, Aaslid R, Newell DW: Compa-
rison of static and dynamic cerebral autoregulation
measurements. Stroke 26:1014–1019, 1995.
51. Mascia L, Andrews PJ, McKeating EG, et al: Cere-
bral blood flow and metabolism in severe brain
injury: The role of pressure autoregulation during
cerebral perfusion pressure management. Intensive
Care Med 26:202–205, 2002.
Bibliografía
2684
Cuidados críticos
VII