Por que a monitoração da pressão intracraniana é importante no traumatismo cranioencefálico?

Resumo

A hipertensão intracraniana continua a ser a causa mais frequente de morte em pacientes com traumatismo cranioencefálico. Assim, a monitoração invasiva da pressão intracraniana consiste em ferramenta de grande importância em neurointensivismo. Recentemente, resultados de um ensaio clínico questionaram a aplicação desse método. Neste artigo, realizamos uma revisão sumária da literatura referente às evidências atuais e relevância clínica da monitoração invasiva de pressão intracraniana.

Abstract

Intracranial hypertension (IH) remains the most frequent cause of death in patients with traumatic brain injury (TBI). Thus invasive monitoring of intracranial pressure is an important tool in these patients. Recently, results of a clinical trial questioned the application of this method. This paper presents a review of the literature about evidence and clinical concerns of invasive intracranial pressure monitoring.

Palavras-chave

traumatismos craniocerebrais - pressão intracraniana - hipertensão intracraniana/diagnóstico - hipertensão intracraniana/terapia

Keywords

craniocerebral trauma - intracranial pressure - intracranial hypertension/diagnosis - intracranial hypertension/therapy

• Referências

• 1 Andrade AF, Paiva WS, Amorim RL , et al. Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling. Arq Neuropsiquiatr 2011; 69 (1) 79-84
• 2 Stocchetti N, Longhi L, Magnoni S, Roncati Zanier E, Canavesi K. Head injury, subarachnoid hemorrhage and intracranial pressure monitoring in Italy. Acta Neurochir (Wien) 2003; 145 (9) 761-765
• 3 Brain Trauma Foundation. Bratton SL, Chestnut RM, Ghajar J. , et al. Guidelines for the management of severe traumatic brain injury. XV. Steroids. J Neurotrauma 2007; 24 (Suppl. 01) 91-95
• 4 Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ. Specialist neurocritical care and outcome from head injury. Intensive Care Med 2002; 28 (5) 547-553
• 5 Fakhry SM, Trask AL, Waller MA, Watts DD ; IRTC Neurotrauma Task Force. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. J Trauma 2004; 56 (3) 492-499
• 6 Le Roux P. Intracranial pressure after the BEST TRIP trial: a call for more monitoring. Curr Opin Crit Care 2014; 20 (2) 141-147
• 7 Chesnut RM, Temkin N, Carney N , et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367 (26) 2471-2481
• 8 Kirkman MA, Smith M. Intracranial pressure monitoring, cerebral perfusion pressure estimation, and ICP/CPP-guided therapy: a standard of care or optional extra after brain injury?. Br J Anaesth 2014; 112 (1) 35-46
• 9 Raboel PH, Bartek Jr J, Andresen M, Bellander BM, Romner B. Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods-A Review. Crit Care Res Pract. 2012; ;2012:950393. doi: 10.1155/2012/950393.
• 10 Hutchinson PJ, Kolias AG, Czosnyka M, Kirkpatrick PJ, Pickard JD, Menon DK. Intracranial pressure monitoring in severe traumatic brain injury. BMJ 2013; 346: f1000
• 11 Ghajar J, Carney N. Intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2013; 368 (18) 1749
• 12 Maas AI, Dearden M, Teasdale GM , et al. EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien) 1997; 139 (4) 286-294
• 13 Bulger EM, Nathens AB, Rivara FP , et al. Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 2002; 30 (8) 1870-1876
• 14 Stocchetti N, Penny KI, Dearden M , et al. Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium. Intensive Care Med 2001; 27 (2) 400-406
• 15 Sahjpaul R, Girotti M. Intracranial pressure monitoring in severe traumatic brain injury--results of a Canadian survey. Can J Neurol Sci 2000; 27 (2) 143-147
• 16 Marion DW, Spiegel TP. Changes in the management of severe traumatic brain injury: 1991–1997. Crit Care Med 2000; 28 (1) 16-18
• 17 Matta B, Menon D. Severe head injury in the United Kingdom and Ireland: a survey of practice and implications for management. Crit Care Med 1996; 24 (10) 1743-1748