MANEJO TERAPÊUTICO DO TRAUMA CRANIOENCEFÁLICO NA FASE AGUDA: PROTOCOLOS DE RESSUSCITAÇÃO E NEUROPROTEÇÃO
DOI:
https://doi.org/10.56238/isevmjv5n1-021Palavras-chave:
Traumatismo Craneoencefálico, Trauma, MortalidadResumo
O trauma cranioencefálico (TCE) moderado a grave (msTBI) é um desafio crítico global, exigindo neuroprognosticação precisa para guiar triagem e decisões sobre retirada de suporte vital. A abordagem contemporânea enfatiza a monitorização multimodal, onde a medição invasiva da Pressão Intracraniana (PIC) é crescentemente suplementada pela Pressão de Oxigênio Tecidual Cerebral, um marcador crucial da hipóxia tecidual que se correlaciona independentemente com desfechos desfavoráveis. Paralelamente, o avanço dos biomarcadores séricos notadamente GFAP, NfL e UCH-L1 permite a avaliação da severidade da lesão e o monitoramento da trajetória clínica com métodos minimamente invasivos. Modelos preditivos estabelecidos, como IMPACT (com AUCs de até 0.85 para mortalidade) e CRASH, oferecem confiabilidade moderada, mas a qualidade da evidência para estes modelos é frequentemente rebaixada devido ao viés de self-fulfilling prophecy e à heterogeneidade na avaliação de desfechos funcionais). No cenário pediátrico, as particularidades da lesão exigem o uso de Ressonância Magnética (RM) avançada, diferentemente da dependência do TC em adultos. A integração desses dados objetivos é imperativa para fundamentar a intervenção aguda que inclui o manejo da PIC e o uso criterioso de terapias hiperosmolares e para o planejamento da reabilitação a longo prazo, sendo que preditores como a ausência de reatividade pupilar bilateral são considerados moderadamente confiáveis para mortalidade hospitalar.
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