Manejo de la vía aérea en pacientes con deterioro neurológico agudo: revisión narrativa de estrategias clínicas en emergencias
DOI:
https://doi.org/10.71112/3rxe2342Palabras clave:
Intubación, Neurología, Emergencia, Hipoxia, Lidocaína, Convulsiones, TraumaResumen
En los servicios de Emergencia y Cuidados Críticos es vital mantener la vía aérea en pacientes neurológicos en estado de deterioro
El presente trabajo tiene como objetivo proporcionar un análisis actual de la valoración y gestión de la vía aérea en situaciones de alteración de la conciencia, tomando en cuenta las problemáticas fisiopatológicas y las estrategias farmacológicas y técnicas sugeridas.
Se llevaron a cabo análisis para la intubación temprana, la elección de agentes de inducción en función del estado neurológico, y las repercusiones hipoxémicas e hipercápnicas en el resultado neurológico.
El objetivo es analizar según la bibliografía reciente y con evidencia para plantear que acciones a implementar pueden funcionar como instrumentos prácticos para orientar el tratamiento durante episodios agudos y, en particular, asistir en la gestión segura y razonable de la vía aérea del paciente neurológicamente afectado y en estado de deterioro.
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Anderson, J., Ebeid, A., & Stallwood-Hall, C. (2022). Pre-hospital tracheal intubation in severe traumatic brain injury: A systematic review and meta-analysis. British Journal of Anaesthesia, 129(6), 977–984. https://doi.org/10.1016/j.bja.2022.07.033 DOI: https://doi.org/10.1016/j.bja.2022.07.033
Bunya, N., Hirofumi, O., Igarashi, Y., Norii, T., Katayama, Y., Kasai, T., Sawamoto, K., & Narimatsu, E. (2023). Effect of prehospital advanced airway management on out‐of‐hospital cardiac arrest due to asphyxia: A JAAM‐OHCA registry‐based observational study in Japan. Acute Medicine & Surgery, 10(1). https://doi.org/10.1002/ams2.912 DOI: https://doi.org/10.1002/ams2.912
Cho, N. J., Park, S., Lyu, J., Lee, H., Hong, M., Lee, E. Y., & Gil, H. W. (2022). Prediction model of acute respiratory failure in patients with acute pesticide poisoning by intentional ingestion: Prediction of respiratory failure in pesticide intoxication (PREP) scores in cohort study. Journal of Clinical Medicine, 11(4). https://doi.org/10.3390/jcm11041048 DOI: https://doi.org/10.3390/jcm11041048
Conzelmann, M., Hoidis, A., Bruckner, T., Popp, E., & Koschny, R. (2021). Aspiration risk in relation to Glasgow Coma Scale score and clinical parameters in patients with severe acute alcohol intoxication: A single-centre, retrospective study. BMJ Open, 11(10). https://doi.org/10.1136/bmjopen-2021-053619 DOI: https://doi.org/10.1136/bmjopen-2021-053619
Dharanindra, M., Jedge, P. P., Patil, V. C., Kulkarni, S. S., Shah, J., Iyer, S., & Dhanasekaran, K. S. (2023). Endotracheal intubation with King Vision video laryngoscope vs Macintosh direct laryngoscope in ICU: A comparative evaluation of performance and outcomes. Indian Journal of Critical Care Medicine, 27(2), 101–106. https://doi.org/10.5005/jp-journals-10071-24398 DOI: https://doi.org/10.5005/jp-journals-10071-24398
Filippelli, O. S. G., Giglio, A. M., Tiburzi, S. P., Archinà, M. T., Barozzi, E., Maglio, P., Candido, S., Viotti, R., Riccelli, U., Pezzi, M., Romano, C., Scozzafava, A. M., & Guzzo, M. L. (2021). Management of airways through rapid tracheostomy in a severely burnt patient attended to via helicopter. Case Reports in Emergency Medicine, 2021, 1–3. https://doi.org/10.1155/2021/5590275 DOI: https://doi.org/10.1155/2021/5590275
Flores Valdez, J. E., Martínez, L. C., Arias, J. C., & Peña, S. (2021). Manejo de la vía aérea mediante intubación submental en fracturas maxilofaciales. Alerta: Revista científica del Instituto Nacional de Salud, 4(3), 103–108. https://doi.org/10.5377/alerta.v4i3.11276 DOI: https://doi.org/10.5377/alerta.v4i3.11276
George, N., Consunji, G., Storkersen, J., Dong, F., Archambeau, B., Vara, R., Serrano, J., Hajjafar, R., Tran, L., & Neeki, M. M. (2022). Comparison of emergency airway management techniques in the performance of emergent cricothyrotomy. International Journal of Emergency Medicine, 15(1). https://doi.org/10.1186/s12245-022-00427-3 DOI: https://doi.org/10.1186/s12245-022-00427-3
González Balenciaga, M., & Balenciaga Traumatismo, G. M. (2020). Traumatismo craneal. Sociedad Española de Urgencias de Pediatría, 233–245. http://www.aeped.es/protocolos/
Hawkins, R. B., Raymond, S. L., Hamann, H. C., Taylor, J. A., Mustafa, M. M., Islam, S., & Larson, S. D. (2020). Outcomes after prehospital endotracheal intubation in suburban/rural pediatric trauma. Journal of Surgical Research, 249, 138–144. https://doi.org/10.1016/j.jss.2019.11.034 DOI: https://doi.org/10.1016/j.jss.2019.11.034
Hawryluk, G. W. J., Lulla, A., Bell, R., Jagoda, A., Mangat, H. S., Bobrow, B. J., & Ghajar, J. (2023a). Guidelines for prehospital management of traumatic brain injury 3rd edition: Executive summary. Neurosurgery, 93(6), E159–E169. https://doi.org/10.1227/neu.0000000000002672
Hawryluk, G. W. J., Lulla, A., Bell, R., Jagoda, A., Mangat, H. S., Bobrow, B. J., & Ghajar, J. (2023b). Guidelines for prehospital management of traumatic brain injury 3rd edition: Executive summary. Neurosurgery, 93(6), E159–E169. https://doi.org/10.1227/neu.0000000000002672 DOI: https://doi.org/10.1227/neu.0000000000002672
Hubbard, M. E., Pena, I., Freeman, D., & Tummala, R. P. (2020). Neurosurgeons performing tracheostomies – Maintaining proficiency in the modern era. Clinical Neurology and Neurosurgery, 192. https://doi.org/10.1016/j.clineuro.2020.105681 DOI: https://doi.org/10.1016/j.clineuro.2020.105681
Jain, U., McCunn, M., Smith, C. E., & Pittet, J. F. (2016). Management of the traumatized airway. Anesthesiology, 124(1), 199–206. https://doi.org/10.1097/ALN.0000000000000903 DOI: https://doi.org/10.1097/ALN.0000000000000903
Javaid, H., Shafique, S., Ajay, K., Zubair, F., & Sultan, S. F. (2021). Challenges in the endotracheal intubation of a patient with severe spine curvature abnormality. Cureus. https://doi.org/10.7759/cureus.18161 DOI: https://doi.org/10.7759/cureus.18161
Jung, J. Y. (2015a). Airway management of patients with traumatic brain injury/C-spine injury. Korean Journal of Anesthesiology, 68(3), 213–219. https://doi.org/10.4097/kjae.2015.68.3.213
Jung, J. Y. (2015b). Airway management of patients with traumatic brain injury/C-spine injury. Korean Journal of Anesthesiology, 68(3), 213–219. https://doi.org/10.4097/kjae.2015.68.3.213 DOI: https://doi.org/10.4097/kjae.2015.68.3.213
Lapostolle, F., & Alhéritière, A. (2020). To intubate or not intubate, that is still the question! European Journal of Emergency Medicine, 27(5), 387–388. https://doi.org/10.1097/MEJ.0000000000000726 DOI: https://doi.org/10.1097/MEJ.0000000000000726
Luckscheiter, A., Thiel, M., Zink, W., Eisenberger, J., Viergutz, T., & Schneider-Lindner, V. (2025). Utilization of non-invasive ventilation before prehospital emergency anesthesia in trauma – A cohort analysis with machine learning. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1). https://doi.org/10.1186/s13049-025-01350-1 DOI: https://doi.org/10.1186/s13049-025-01350-1
Orso, D., Vetrugno, L., Federici, N., D’Andrea, N., & Bove, T. (2020). Endotracheal intubation to reduce aspiration events in acutely comatose patients: A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28(1). https://doi.org/10.1186/s13049-020-00814-w DOI: https://doi.org/10.1186/s13049-020-00814-w
Parks, D. J., Alter, S. M., Shih, R. D., Solano, J. J., Hughes, P. G., & Clayton, L. M. (2020). Rescue intubation in the emergency department after prehospital ketamine administration for agitation. Prehospital and Disaster Medicine, 35(6), 651–655. https://doi.org/10.1017/S1049023X20001168 DOI: https://doi.org/10.1017/S1049023X20001168
Prekker, M. E., Driver, B. E., Trent, S. A., Resnick-Ault, D., Seitz, K. P., Russell, D. W., … Semler, M. W. (2023). Video versus direct laryngoscopy for tracheal intubation of critically ill adults. New England Journal of Medicine, 389(5), 418–429. https://doi.org/10.1056/nejmoa2301601 DOI: https://doi.org/10.1056/NEJMoa2301601
Puolakkainen, T., Toivari, M., Puolakka, T., & Snäll, J. (2022). “A” stands for airway – Which factors guide the need for on-scene airway management in facial fracture patients? BMC Emergency Medicine, 22(1). https://doi.org/10.1186/s12873-022-00669-7 DOI: https://doi.org/10.1186/s12873-022-00669-7
Robinson, C. (2022). Emergency neurological life support: Airway, ventilation and sedation protocol version 5.0.
Rubén Viejo-Moreno, Jiménez-Carrascosa, J. F., & Parra-Soriano, S. (2021). Análisis descriptivo de pacientes que requirieron manejo avanzado de vía aérea en emergencias prehospitalarias: Complicaciones y factores asociados al fracaso en el primer intento de intubación. Emergencias, 33, 447–453.
Saviluoto, A., Pappinen, J., Kirves, H., Raatiniemi, L., & Nurmi, J. (2023). Association between physician’s case volume in prehospital advanced trauma care and 30-day mortality: A registry-based analysis of 4,032 patients. Journal of Trauma and Acute Care Surgery, 94(3), 425–432. https://doi.org/10.1097/TA.0000000000003777 DOI: https://doi.org/10.1097/TA.0000000000003777
Suzuki, N., Doi, T., Abe, T., Michishita, T., Gakumazawa, M., & Takeuchi, I. (2024). Predictors of emergency interventions in acute airway obstructive diseases: A retrospective single-center observational study. Cureus. https://doi.org/10.7759/cureus.71031 DOI: https://doi.org/10.7759/cureus.71031
Takawira, N., Han, R. J., Nguyen, T. Q., Gaines, J. D., & Han, T. H. (2012). Spinal cord stimulator and epidural haematoma. British Journal of Anaesthesia, 109(4), 649–650. https://doi.org/10.1093/bja/aes335 DOI: https://doi.org/10.1093/bja/aes335
Tamilarasu, K. P., Aazmi, A., Vinayagam, S., Rajendran, G., Patel, S., & Aazmi, B. (2023). A prospective observational study of endotracheal intubation practices in an academic emergency department of a tertiary care hospital in South India. Cureus. https://doi.org/10.7759/cureus.36072 DOI: https://doi.org/10.7759/cureus.36072
Van Helmond, L. P. F. M., & Gresnigt, F. M. J. (2020). Safety of withholding intubation in gamma-hydroxybutyrate- and gamma-butyrolactone-intoxicated coma patients in the emergency department. European Journal of Emergency Medicine, 27(3), 223–227. https://doi.org/10.1097/MEJ.0000000000000649 DOI: https://doi.org/10.1097/MEJ.0000000000000649
West, J. R., O’Keefe, B. P., & Russell, J. T. (2021). Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation. Trauma Surgery and Acute Care Open, 6(1). https://doi.org/10.1136/tsaco-2020-000588 DOI: https://doi.org/10.1136/tsaco-2020-000588
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