MANEJO TERAPÉUTICO DEL TRAUMATISMO CRANEOENCEFÁLICO EN LA FASE AGUDA: PROTOCOLOS DE REANIMACIÓN Y NEUROPROTECCIÓN
DOI:
https://doi.org/10.56238/isevmjv5n1-021Palabras clave:
Trauma Cranioencefálico, Trauma, MortalidadeResumen
El traumatismo craneoencefálico (TCE) moderado a grave representa un desafío crítico a nivel mundial, que requiere una neuroprognosticación precisa para orientar el triaje y las decisiones sobre la retirada del soporte vital. El abordaje contemporáneo enfatiza la monitorización multimodal, en la cual la medición invasiva de la Presión Intracraneal (PIC) se complementa cada vez más con la Presión de Oxígeno Tisular Cerebral (PbtO₂), un marcador crucial de hipoxia tisular asociado de manera independiente con desenlaces desfavorables.Paralelamente, los avances en biomarcadores séricos—en particular la proteína ácida fibrilar glial (GFAP), la cadena ligera de neurofilamento (NfL) y la ubiquitina carboxi-terminal hidrolasa L1 (UCH-L1)—permiten evaluar la gravedad de la lesión y monitorizar la trayectoria clínica mediante métodos mínimamente invasivos. Modelos predictivos establecidos, como IMPACT y CRASH, ofrecen una confiabilidad moderada (con valores de AUC de hasta 0,85 para mortalidad en el modelo IMPACT); sin embargo, la calidad de la evidencia suele verse reducida debido al sesgo de profecía autocumplida y a la heterogeneidad en la evaluación de desenlaces funcionales. En el contexto pediátrico, las particularidades de la lesión exigen mayor utilización de la Resonancia Magnética (RM) avanzada, a diferencia de la dependencia predominante de la tomografía computarizada (TC) en adultos. La integración de estos datos objetivos es fundamental para orientar la intervención aguda—incluyendo el manejo de la PIC y el uso prudente de terapias hiperosmolares—y para la planificación de la rehabilitación a largo plazo. Predictores como la ausencia bilateral de reactividad pupilar se consideran indicadores moderadamente confiables de mortalidad intrahospitalaria.
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