Monitorização da pressão intracraniana como exame complementar no diagnóstico de morte encefálica: observação preliminar através do registro de dois casos

Agapejev, Svetlana; Silva, Pedro Paulo Thimoteo da; Zanini, Marco Antonio; Piza, Edmur Toledo

doi:10.1590/S0004-282X1997000200021

Resumos

Estudou-se retrospectivamente a evolução clínica de dois pacientes, até sua falência cardíaca irreversível (FCI), submetidos à monitorização contínua da pressão intracraniana (PIC). O estudo detalhado desses traçados mostrou que, nos dois casos a PIC atingiu valores máximos 5 e 12 h antes de ocorrer diminuição na amplitude das ondas, observada 47 e 60 h pré-FCI. Essa diminução foi progressiva e tornou-se linear cerca de 30 h antes da FCI, em ambos os casos. O diagnóstico clínico de morte encefálica (ME) foi obtido 3 e 28 hs após a linearidade do traçado. Os autores sugerem que o diagnóstico de ME pode ser definido mais precocemente com o uso da monitorização da PIC desde que o paciente não esteja sob sedação, e salientam a necessidade de mais observações, em número maior de pacientes.

pressão intracraniana; monitorização; morte encefálica

The clinical evolution of two patients with continuous intracranial pressure (ICP) monitoring, admitted to the Intensive Care Unit of Neurology, University Hospital of Botucatu, and followed until irreversible cardiac failure (ICF) was studied retrospectively. The evolution of ICP showed that it reached a maximum 5 to 12 hours before a decrease in wave amplitude occurred (this was observed approximately 47 to 60 hours before ICF). The tracing became linear approximately 30 hours before ICF in both cases. The clinical diagnosis of brain death (BD) was obtained 3 to 28 hours after the tracing had become linear. The authors suggest that, in abscence of sedation, the diagnosis of BD may be made early with the use of ICP monitoring even before the clinical diagnosis, and emphasize the need for more observations in a larger number of patients.

intracranial pressure; monitoring; brain death

Monitorização da pressão intracraniana como exame complementar no diagnóstico de morte encefálica: observação preliminar através do registro de dois casos

Intracranial pressure monitoring as a complementary diagnosis of brain death: preliminary observation through the report of two cases

Svetlana Agapejev^I; Pedro Paulo Thimoteo da Silva^II; Marco Antonio Zanini^III; Edmur Toledo Piza^II

^IHospital das Clínicas da Faculdade de Medicina da Universidade Estadual Paulista (UNESP), Botucatu, Estado de São Paulo: Professor Doutor, Disciplina de Neurologia

^IIHospital das Clínicas da Faculdade de Medicina da Universidade Estadual Paulista (UNESP), Botucatu, Estado de São Paulo: Residente de Neurocirurgia

^IIIHospital das Clínicas da Faculdade de Medicina da Universidade Estadual Paulista (UNESP), Botucatu, Estado de São Paulo: Auxiliar de Ensino, Disciplina de Neurocirurgia

RESUMO

Estudou-se retrospectivamente a evolução clínica de dois pacientes, até sua falência cardíaca irreversível (FCI), submetidos à monitorização contínua da pressão intracraniana (PIC). O estudo detalhado desses traçados mostrou que, nos dois casos a PIC atingiu valores máximos 5 e 12 h antes de ocorrer diminuição na amplitude das ondas, observada 47 e 60 h pré-FCI. Essa diminução foi progressiva e tornou-se linear cerca de 30 h antes da FCI, em ambos os casos. O diagnóstico clínico de morte encefálica (ME) foi obtido 3 e 28 hs após a linearidade do traçado. Os autores sugerem que o diagnóstico de ME pode ser definido mais precocemente com o uso da monitorização da PIC desde que o paciente não esteja sob sedação, e salientam a necessidade de mais observações, em número maior de pacientes.

Palavras-chave: pressão intracraniana, monitorização, morte encefálica.

ABSTRACT

The clinical evolution of two patients with continuous intracranial pressure (ICP) monitoring, admitted to the Intensive Care Unit of Neurology, University Hospital of Botucatu, and followed until irreversible cardiac failure (ICF) was studied retrospectively. The evolution of ICP showed that it reached a maximum 5 to 12 hours before a decrease in wave amplitude occurred (this was observed approximately 47 to 60 hours before ICF). The tracing became linear approximately 30 hours before ICF in both cases. The clinical diagnosis of brain death (BD) was obtained 3 to 28 hours after the tracing had become linear. The authors suggest that, in abscence of sedation, the diagnosis of BD may be made early with the use of ICP monitoring even before the clinical diagnosis, and emphasize the need for more observations in a larger number of patients.

Key words: intracranial pressure, monitoring, brain death.

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10. Sirovski EB. On the mechanisms of the development of CSF pressure spontaneous fluctuations (plato and β waves). Z Vopr Nevrokhirurlment 1991;3:18-23.

Aceite: 25-novembro-1996.

Dra. Svetlana Agapejev - Departamento de Neurologia - Faculdade de Medicina, UNESP - Caixa Postal 540 -18618-000 Botucatu SP - Brasil.

1. Allen R. Intracranial pressure: a review of clinical problems, measurement techniques and monitoring methods. J Med Eng & Techn 1986;10:299-320.
2. Brihaey J, Walker AE. Brain Death. Acta Neurochir (Wien) 1990;105:78-86.
3. Dantas VPD Filho, Torres MP, Araújo S, Vieira RJ, Falcão ALE, Sardinha LAC, Terzi RGG. Morte encefálica: considerações gerais e protocolo para seu diagnóstico. Rev Bras Terap Intens 1992;4:50-54.
4. Dominguez-Roldán JM, Murillo-Cabezas F, Muñoz-Sanchez A, Gonzales-Menendez E. High-risk injuries leading to cerebral death: early detection of potential organ donors. Transpl Proc 1992;24:29-30.
5. Gros C. Les critères circulatoires et biologiques de la mort du cerveau (à l'éxclusion des problèmes cliniques et electroencephalographiques). Neurochirurgie 1972:18 9-48.
6. Lundberg H, Troupp H, Lorin H. Continous recording of the ventricular fluid pressure in patients with severe acute traumatic brain injury. J Neurosurg 1965;22:581-590.
7. Obana WG, Andrews BT. The neurologic examination and neurologic monitoring in the intensive care unit. In Andrews BT. Neurosurgical intensive care. San Francisco: McGraw-Hill, 1993:31-40.
8. Ropper AH. Neurological intensive care. Ann Neurol 1992;32:564-569.
9. Shivalkar B, Looni JV, Wieland W, Tjandra-Maga TB, Borgers M, Plets C, Flameng W. Variable effects of explosive and gradual increase of intracranial pressure on myocardial structure and function. Circulation 1993:87:230-239.
11. Unwin DH, Giller CA, Kopitnik TA. Central nervous system monitoring: what helps, what does not. Surg Clin North Am 1991;71:733-747.
12. Unterberg A, Kiening K, Schmiedek P, Lanksch W. Long-term observations of intracranial pressure after severe head injury: the phenomenon of secondary rise of intracranial pressure. Neurosurgery 1993;32:17-24.
13. Walker AE. Brain death. Ed 3. München: Urban & Schwarzenberg, 1985.
14. Zabramski JM, Spetzler RF. Surgery of intracranial aneurysms. In Barnett HJM, Mohr JP, Stein BM, Yatsu FM. Stroke: pathophysiology, diagnosis and management. Ed 2. New York: Churchill Livingstone, 1992:1055-1092.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
Jun 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Allen R. Intracranial pressure: a review of clinical problems, measurement techniques and monitoring methods. J Med Eng & Techn 1986;10:299-320.

[2] 2. Brihaey J, Walker AE. Brain Death. Acta Neurochir (Wien) 1990;105:78-86.

[3] 3. Dantas VPD Filho, Torres MP, Araújo S, Vieira RJ, Falcão ALE, Sardinha LAC, Terzi RGG. Morte encefálica: considerações gerais e protocolo para seu diagnóstico. Rev Bras Terap Intens 1992;4:50-54.

[4] 4. Dominguez-Roldán JM, Murillo-Cabezas F, Muñoz-Sanchez A, Gonzales-Menendez E. High-risk injuries leading to cerebral death: early detection of potential organ donors. Transpl Proc 1992;24:29-30.

[5] 5. Gros C. Les critères circulatoires et biologiques de la mort du cerveau (à l'éxclusion des problèmes cliniques et electroencephalographiques). Neurochirurgie 1972:18 9-48.

[6] 6. Lundberg H, Troupp H, Lorin H. Continous recording of the ventricular fluid pressure in patients with severe acute traumatic brain injury. J Neurosurg 1965;22:581-590.

[7] 7. Obana WG, Andrews BT. The neurologic examination and neurologic monitoring in the intensive care unit. In Andrews BT. Neurosurgical intensive care. San Francisco: McGraw-Hill, 1993:31-40.

[8] 8. Ropper AH. Neurological intensive care. Ann Neurol 1992;32:564-569.

[9] 9. Shivalkar B, Looni JV, Wieland W, Tjandra-Maga TB, Borgers M, Plets C, Flameng W. Variable effects of explosive and gradual increase of intracranial pressure on myocardial structure and function. Circulation 1993:87:230-239.

[10] 11. Unwin DH, Giller CA, Kopitnik TA. Central nervous system monitoring: what helps, what does not. Surg Clin North Am 1991;71:733-747.

[11] 12. Unterberg A, Kiening K, Schmiedek P, Lanksch W. Long-term observations of intracranial pressure after severe head injury: the phenomenon of secondary rise of intracranial pressure. Neurosurgery 1993;32:17-24.

[12] 13. Walker AE. Brain death. Ed 3. München: Urban & Schwarzenberg, 1985.

[13] 14. Zabramski JM, Spetzler RF. Surgery of intracranial aneurysms. In Barnett HJM, Mohr JP, Stein BM, Yatsu FM. Stroke: pathophysiology, diagnosis and management. Ed 2. New York: Churchill Livingstone, 1992:1055-1092.