Godoy Daniel Agustín, Suarez Pablo David Guerrero, Moscote-Salazar Luis Rafael, Napoli Mario Di
Intensive Care Unit, San Juan Bautista Hospital, Catamarca, Argentina.
Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina.
Bull Emerg Trauma. 2017 Jul;5(3):143-151.
Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ''refractory IH'', with an associated mortality rate of 80-100%. In such cases, hypothermia, barbiturates at high doses (BBT), decompressive craniectomy (DC), and extreme hyperventilation are utilized. However, none of them has proven efficacy. Indomethacin (INDO), a non-steroidal anti-inflammatory drug, may be an option with an acceptable safety profile and easy to administer. Reported series showed encouraging results. We herein present a case of refractory IH after sTBI in which INDO was utilized. In refractory IH, INDO can help to decrease ICP and improve cerebral perfusion pressure. However, it requires administration under strict protocol since it's not free of adverse effects after withdrawal.
颅内高压（IH）是急性脑损伤的最终途径之一。在重度创伤性脑损伤（sTBI）中，它独立预测不良预后。对其进行控制是治疗的关键方面。对传统治疗无反应标志着“难治性IH”状态，相关死亡率为80%-100%。在这种情况下，会采用低温治疗、高剂量巴比妥类药物（BBT）、减压性颅骨切除术（DC）和过度换气。然而，它们均未被证明有效。吲哚美辛（INDO），一种非甾体类抗炎药，可能是一种具有可接受安全性且易于给药的选择。报道的系列病例显示了令人鼓舞的结果。我们在此呈现一例sTBI后难治性IH使用INDO的病例。在难治性IH中，INDO有助于降低颅内压（ICP）并改善脑灌注压。然而，由于停药后并非没有不良反应，因此需要严格按照方案给药。
