Pimentel AEG, Ramírez RJJ, Gómez GN, Jiménez CC, González CPL

Language: Spanish
References: 20
Page: 534-541
PDF size: 247.61 Kb.

ABSTRACT

Introduction: acute brain injury is a critical, life-threatening condition that can be associated to multiple failures. According to the brain trauma foundation, intracranial hypertension is defined as a value of equal or more than 22 mmHg. Control of intracranial pressure is the key to every neurocritical patient. A proper treatment reduces the secondary insult and the mortality that comes with it. Therefore, it is vital to achieve a to achieve a close follow up to every neurocritical patient. Transcranial doppler is a continuous and dynamic and it provides the measurement of the pulsatility index, which correlates with increased intracranial pressure. Within the anti-edema treatment, the effect of saline solution at different concentrations has been evaluated, without referring to a superiority, which is why this protocol evaluates the significant effect on the velocity and pulsatility index of the cerebral artery (MCA) and optic nerve sheath (ONS) measurement in patients receiving 7.5% versus 3% hypertonic saline (HTS) for the management of ICH. Material and methods: cohort, comparative, prospective and analytical, trial was performed, with a sample of 42 patients, both genders, over 18 years with ICH data, eliminating those who failed subsequent administration of hyperosmolar solution, poor sonographic window for taking TCD measurements, who were not administered the hyperosmolar solution in a timely manner. Non-probabilistic sampling due to availability of cases, randomized to receive 3% or 7.5% HTS as a treatment for ICH, calculated at 2 mL/kg of weight, administered for 20 minutes, intravenously and with a 30-minute period for taking new measurement. The primary objective was to determine the effect of therapy with 3% versus 7.5% hypertonic solution as a treatment for ICH by assessing MCA and VNO velocities. Results: we included 42 patients both genders with a mean age of 44.57 ± 14.3 years, in the relationship of the group with HTS 7.5% demonstrated greater efficacy with a p of 0.028 and in the comparison of MCA velocities, greater variance was obtained in the HTS group at 7.5% with a p of 0.04, both groups had a global change in ICP with a p of 0.062. Cerebral perfusion pressure (CPP) had a greater change in the HTS 7.5% group with an AUC of 0.89, p of 0.07 and a difference between areas of 0.0009. Conclusion: the 7.5% hypertonic saline solution presented greater relevance in the treatment of neurocritical patients.

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