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Hipotermia moderada para la hipertensión intracraneal no controlada en la insuficiencia hepática aguda
R Jalan1, S W O Damink, N E Deutz
1Liver Unit, Royal Infirmary of Edinburgh, UK. r.jalan@ed.ac.uk
Lancet (London, England)
|October 8, 1999
Resumen
La hipotermia moderada reduce efectivamente la presión intracraneal en pacientes con insuficiencia hepática aguda, ofreciendo un puente potencial para el trasplante de hígado. Este tratamiento es prometedor para mejorar los resultados en casos críticos.
Área de la Ciencia:
- Hepatología Hepatología.
- El cuidado neurocrítico.
- Medicina de cuidados críticos Medicina de cuidados críticos.
Sus antecedentes:
- La insuficiencia hepática aguda (ALF) plantea un alto riesgo de mortalidad, especialmente cuando se complica por el aumento de la presión intracraneal (ICP).
- Los tratamientos estándar como el mannitol y la ultrafiltración a menudo son insuficientes para la PCI incontrolada en la FAA.
- Investigar nuevas estrategias terapéuticas es crucial para mejorar las tasas de supervivencia en pacientes con ALF con ICP elevado.
Objetivo del estudio:
- Evaluar la seguridad y eficacia de la hipotermia moderada en el manejo de la PCI no controlada en pacientes con FLA.
- Para determinar si la hipotermia puede servir como un puente para el trasplante de hígado ortotópico (OLT).
Principales métodos:
- Siete pacientes con ALF con aumento refractario de ICP se sometieron a hipotermia moderada (temperatura central 32-33 ° C) con el uso de mantas de enfriamiento.
- Los pacientes se enfriaron durante diferentes períodos de tiempo en función de la candidatura de OLT (8 horas para los no candidatos, pre- e intra-OLT para los candidatos).
- Se midieron el flujo sanguíneo cerebral y los índices metabólicos antes y después del enfriamiento.
Principales resultados:
- La hipotermia redujo significativamente la PCI de 45 a 16 mm Hg (p <0,05) y disminuyó el flujo sanguíneo cerebral.
- La presión de perfusión cerebral aumentó significativamente de 45 a 70 mm Hg (p<0.05) durante la hipotermia.
- Cuatro candidatos a OLT fueron puentes exitosos para el trasplante; tres no candidatos murieron después del recalentamiento. No se observaron efectos adversos de hipotermia.
Conclusiones:
- La hipotermia moderada es un tratamiento seguro y eficaz para la PCI no controlada en la FAA.
- La hipotermia puede servir como una terapia de puente crítica, permitiendo la OLT en pacientes con ALF seleccionados.
- Se justifica una mayor investigación sobre el papel de la hipotermia en el manejo de la ALF.
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