Índice Integrado de Autorregulación Cerebral para la Estratificación Temprana del Riesgo en el Traumatismo Craneoencefálico Grave
ICAS para la Estratificación Temprana del Riesgo en la PICU
Autores/as
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Marlon Carbonell Gonzalez
Unidad de Cuidados Intensivos, Hospital Clínico-Quirúrgico “Miguel Enríquez”, Universidad de Ciencias Médicas de La Habana, Cuba.
https://orcid.org/0009-0008-5509-0409
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Rosali Santiago Roibal
Universidad de Ciencias Médicas de Matanzas, Universidad de Ciencias Médicas Juan Guiteras, Matanzas, Cuba
https://orcid.org/0009-0004-7913-7022
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Deborah Cabrera Rodríguez
High Quality Medical Services, Houston, United States
https://orcid.org/0009-0002-1156-0225
- Jorge Luis Ayala Pérez Emergency Medicine Department, Torrevieja University Hospital, Alicante Province, Valencian Community, Spain
DOI:
https://doi.org/10.70099/BJ/2026.03.02.3Palabras clave:
Traumatismo craneoencefálico pediátrico, autorregulación cerebral, índice de reactividad a la presión, presión de perfusión cerebral, cuidados neurocríticos pediátricosResumen
Antecedentes:
La autorregulación cerebral alterada se asocia con peores desenlaces en el traumatismo craneoencefálico (TCE) grave pediátrico. Nuestro objetivo fue identificar predictores tempranos de falla autorregulatoria y desarrollar una herramienta de estratificación del riesgo a la cabecera del paciente, el Pediatric Integrated Cerebral Autoregulation Score (pICAS).
Métodos:
Realizamos un estudio de cohorte retrospectivo multicéntrico que incluyó a 100 niños (0–18 años) con TCE grave (escala de coma de Glasgow ≤8) que requirieron soporte con vasopresores dentro de las primeras 72 horas del ingreso. La monitorización neurológica multimodal continua incluyó presión intracraneal (PIC), presión de perfusión cerebral (PPC), PPC óptima (PPCopt), índice de reactividad a la presión (PRx), oxigenación tisular cerebral (PbtO₂, cuando estuvo disponible) y variabilidad de la presión arterial media (PAM).
Resultados:
La autorregulación cerebral alterada, definida como un PRx medio >0,30, se observó en el 49% de los pacientes. Cinco predictores tempranos —PIC ≥20 mmHg, PRx >0,30 durante más del 35% del tiempo de monitorización, variabilidad de la PAM >12 mmHg, PPC por debajo de la PPCopt durante más del 30% del tiempo y una dosis equivalente de norepinefrina ≥0,1 µg/kg/min— se incorporaron al pICAS (rango de puntuación 0–5), lo que permitió una estratificación del riesgo entre el 10% y el 90%.
Conclusiones:
El pICAS permite una estratificación rápida del riesgo a la cabecera del paciente para la alteración de la autorregulación cerebral en niños con TCE grave y podría apoyar estrategias individualizadas de manejo de la perfusión cerebral.
Citas
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Derechos de autor 2026 Marlon Carbonell Gonzalez, Rosali Santiago Roibal, Deborah Cabrera Rodríguez, Jorge Luis Ayala Pérez (Author)
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