Resumen
INTRODUCCIÓN: el DTC es una técnica de ultrasonido no invasiva que permite evaluar la velocidad ydirección del flujo sanguíneo en los segmentos proximales de las principales arterias cerebrales. Se utiliza principalmente en la evaluación y seguimiento de pacientes con entidades cerebrovasculares, por lo cual se ha convertido en herramienta fundamental de monitoreo multimodal en las unidades de cuidado neurovascular y cuidado neurocrítico.
OBJETIVO: resaltar la importancia del Doppler Transcraneano (DTC) como herramienta diagnóstica y terapéutica en entidades cerebrovasculares complejas manejadas en las unidades de cuidado crítico.
MÉTODOS: se realizó una búsqueda bibliográfica en MEDLINE, uniendo el término transcranial doppler (TCD) con vasoespasm, flow velocity, pulsatility index, stroke y death entre los meses de Febrero y Abril del año 2007, encontrando 1767 artículos publicados entre 1972 y 2006. Se emplearon bases de datos como Hinari, Ovid y Science Direct para acceder a la literatura respectiva. Se incluyeron los estudios observacionales analíticos y experimentales tanto en humanos como en animales que buscaran la utilidad del DTC en las principales entidades neurovasculares. Así mismo se incluyeron siete artículos de revisión referentes al tema.
Posteriormente se realizó un análisis y discusión completa por parte del grupo de ciencias neurovasculares dela Fundación Cardiovascular de Colombia el cual está integrado por neurólogos, epidemiólogos y médicos generales entrenados en el uso del DTC.
Únicamente se revisaron revistas indexadas en MEDLINE, lo que limitó el acceso a la literatura latinoamericana referente al tema.
RESULTADOS: el DTC permite identificar procesos de vasoespasmo posterior a hemorragia subaracnoidea y obstrucciones proximales del flujo, valorar la capacidad de autorregulación cerebral y confirmar el diagnóstico clínico de muerte encefálica. Investigaciones recientes han descrito que su uso puede producir cambios estructurales en el trombo y por lo tanto ser útil como terapia trombolítica co-ayudante.
CONCLUSIONES: el DTC es una herramienta confiable y de bajo costo, importante para el diagnóstico y seguimiento de pacientes con enfermedad neurovascular que requieren cuidado estricto y monitoreo de la presión intracraneana. Apoya el diagnóstico clínico de muerte encefálica, además determina la indicación de transfusión en pacientes con anemia de células falciformes. Se requieren nuevos estudios que confirmen la utilidad del DTC como terapia trombolítica co-ayudante.
Citas
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