Guías del manejo del Trauma Craneal Severo



Les dejo con las últimas Guías de la Brain Trauma Foundation. Pueden acceder a las mismas a través del siguiente link

Hipotermia terapéutica en el trauma craneoencefálico

Hoy les traigo esta interesante revisión de Samantha Crossley sobre la hipotermia en el trauma craneal que encuentra que ésta puede ser beneficiosa.
Les dejo aquí el abstract:

Introduction: Research into therapeutic hypothermia following traumatic brain injury has been characterised by small trials of poor methodological quality, producing variable results. The Cochrane review, published in 2009, now requires updating. The aim of this systematic review is to assess the effectiveness of the application of therapeutic hypothermia to reduce death and disability when administered to adult patients who have been admitted to hospital following traumatic brain injury.

Methods: Two authors extracted data from each trial. Unless stated in the trial report, relative risks and 95%confidence intervals (CIs) were calculated for each trial. We considered P < 0 · 05 to be statistically significant. We combined data from all trials to estimate the pooled risk ratio (RR) with 95% confidence intervals for death,
unfavourable outcome, and pneumonia. All statistical analyses were performed using RevMan 5.1 (Cochrane IMS, Oxford, UK) and Stata (Intercooled Version 12.0, StataCorp LP). Pooled RRs were calculated using the Mantel-Haenszel estimator. The random effects model of DerSimonian and Laird was used to estimate variances for the Mantel-Haenszel and inverse variance estimators
 Results: Twenty studies are included in the review, while 18 provided mortality data. When the results of 18 trials that evaluated mortality as one of the outcomes were statistically aggregated, therapeutic hypothermia was associated with a significant reduction in mortality and a significant reduction in poor outcome. There was a lack of statistical evidence for an association between use of therapeutic hypothermia and increased onset of new pneumonia.

Conclusions: In contrast to previous reviews, this systematic review found some evidence to suggest that therapeutic hypothermia may be of benefit in the treatment of traumatic brain injury. The majority of trials were of low quality, with unclear allocation concealment. Low quality trials may overestimate the effectiveness of hypothermia treatment versus standard care. There remains a need for more, high quality, randomised control trials of therapeutic hypothermia after traumatic brain injury.  

Pueden acceder al articulo completo a través de este enlace

¿Profilaxis antibiótica en la fractura de la base de cráneo?

Las fracturas de base del cráneo predisponen a los pacientes a la meningitis debido al posible contacto directo de las bacterias de los senos paranasales, la nasofaringe o el oído medio con el sistema nervioso central. La pérdida de líquido cefalorraquídeo  ha sido asociada con un mayor riesgo de contraer meningitis. Generalmente, se administran antibióticos como profilaxis, aunque su función para prevenir la meningitis bacteriana aún no está establecida. Les dejo un artículo reciente publicado en la revista Laryngoscope que hace una pequeña revisión sobre este tema donde concluyen que no existe evidencia de administrarlos o no profilácticamente. Pueden acceder al mismo a través de la revista Laryngoscope

Craniectomía descompresiva y sus complicaciones

Hoy les invito a leer este artículo publicado por nuestro grupo sobre las craniectomías descompresivas y sus complicaciones en el trauma craneoencefálico severo con hipertensión intracraneal refractaria a tratamiento médico. Pueden leerlo de forma completa a través del último número de la revista International Journal of Critical Illness and Injury Science.