Impacto de la secuencia de intubación rápida sobre la presión intracraneal y la perfusión cerebral en pacientes con traumatismo craneoencefálico: una scoping review
DOI:
https://doi.org/10.71112/g3wtt473Palavras-chave:
Traumatismo craneoencefálico, secuencia de intubación rápida, presión intracraneal, presión de perfusión cerebral, hemodinamia, manejo de la vía aérea, ketamina, dexmedetomidina, neurocrítico, hipoxia, hipotensión.Resumo
El traumatismo craneoencefálico representa una causa significativa de morbimortalidad, en la cual la prevención del daño cerebral secundario es determinante. La secuencia de intubación rápida es una intervención frecuente en el manejo inicial, pero puede generar alteraciones en la presión intracraneal y la perfusión cerebral. Se realizó una scoping review siguiendo la metodología PRISMA-ScR para mapear la evidencia disponible sobre el impacto de la secuencia de intubación rápida en la presión intracraneal y la presión de perfusión cerebral en pacientes adultos con traumatismo craneoencefálico.
Se incluyeron 20 estudios tras la evaluación de 500 registros iniciales, abarcando ensayos clínicos, estudios observacionales y revisiones sistemáticas. Los hallazgos muestran que el impacto de la secuencia de intubación rápida sobre la dinámica intracraneal depende de múltiples factores, incluyendo la fase del procedimiento, la elección de agentes farmacológicos y el control hemodinámico y ventilatorio. La evidencia sugiere que la hipotensión postintubación y la hipoxemia tienen mayor impacto negativo sobre la perfusión cerebral que los incrementos transitorios de la presión intracraneal. Asimismo, la ketamina se asocia con un perfil hemodinámico favorable y no demuestra aumento perjudicial de la presión intracraneal, mientras que la dexmedetomidina emerge como un adyuvante útil en contextos seleccionados.
Las estrategias para mitigar el impacto intracraneal deben abordarse mediante un enfoque multimodal que incluya optimización de la preoxigenación, control del dióxido de carbono, prevención de la hipotensión y técnicas que maximicen el éxito al primer intento de intubación. La evidencia disponible presenta limitaciones metodológicas, con predominio de estudios observacionales y heterogeneidad en los métodos de medición.
En conclusión, la secuencia de intubación rápida en pacientes con traumatismo craneoencefálico debe ser considerada una intervención neurocrítica, en la cual la preservación de la perfusión cerebral y el control fisiológico integral son fundamentales para mejorar los desenlaces clínicos.
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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. In British Journal of Anaesthesia (Vol. 129, Number 6, pp. 977–984). Elsevier Ltd. https://doi.org/10.1016/j.bja.2022.07.033 DOI: https://doi.org/10.1016/j.bja.2022.07.033
Barea-Mendoza, J. A., Chico-Fernández, M., Ballesteros, M. A., Caballo Manuel, A., Castaño-Leon, A. M., Egea-Guerrero, J. J., Lagares, A., Morales-Varas, G., Pérez-Bárcena, J., Serviá Goixart, L., & Llompart-Pou, J. A. (2024). Resuscitation and Initial Management After Moderate-to-Severe Traumatic Brain Injury: Questions for the On-Call Shift. In Journal of Clinical Medicine (Vol. 13, Number 23). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/jcm13237325 DOI: https://doi.org/10.3390/jcm13237325
Bossers, S. M., Mansvelder, F., Loer, S. A., Boer, C., Bloemers, F. W., Van Lieshout, E. M. M., Den Hartog, D., Hoogerwerf, N., van der Naalt, J., Absalom, A. R., Schwarte, L. A., Twisk, J. W. R., Schober, P., de Boer, A., Goslings, J. C., van Helden, S. H., Hesselink, D., van Aken, G., Beishuizen, A., … Kooij, F. O. (2023). Association between prehospital end-tidal carbon dioxide levels and mortality in patients with suspected severe traumatic brain injury. Intensive Care Medicine, 49(5), 491–504. https://doi.org/10.1007/s00134-023-07012-z DOI: https://doi.org/10.1007/s00134-023-07012-z
Butterfield, M., Bodnar, D., Williamson, F., Parker, L., & Ryan, G. (2023). Prevalence of secondary insults and outcomes of patients with traumatic brain injury intubated in the prehospital setting: a retrospective cohort study. Emergency Medicine Journal, 40(3), 167–174. https://doi.org/10.1136/emermed-2022-212513 DOI: https://doi.org/10.1136/emermed-2022-212513
Carney, N., Totten, A. M., Cheney, T., Jungbauer, R., Neth, M. R., Weeks, C., Davis-O’Reilly, C., Fu, R., Yu, Y., Chou, R., & Daya, M. (2021). Prehospital Airway Management: A Systematic Review. Prehospital Emergency Care, 26(5), 716–727. https://doi.org/10.1080/10903127.2021.1940400 DOI: https://doi.org/10.1080/10903127.2021.1940400
Chen, X., Yang, C., Zhao, Y., Gao, J., Ge, Y., & Zhang, Y. (2025). Transnasal humidified rapid insufflation ventilatory exchange versus conventional facemask breathing for preoxygenation during anesthesia induction in TBI surgery: a randomized controlled trial. European Journal of Medical Research. https://doi.org/10.1186/s40001-025-03702-0 DOI: https://doi.org/10.1186/s40001-025-03702-0
Chinnarasan, V. C., Bidkar, P. U., Swaminathan, S., Mani, M., Vairappan, B., Chatterjee, P., Joy, J. J., Dey, A., Ramadurai, R., & Gunasekaran, A. (2024). Comparison of dexmedetomidine versus fentanyl-based total intravenous anesthesia technique on the requirement of propofol, brain relaxation, intracranial pressure, neuronal injury, and hemodynamic parameters in patients with acute traumatic subdural hematoma undergoing emergency craniotomy: A randomized controlled trial. Surgical Neurology International, 15. https://doi.org/10.25259/SNI_892_2024 DOI: https://doi.org/10.25259/SNI_892_2024
Choo, Y. H., Seo, Y., & Oh, H. J. (2023). Deep Sedation in Traumatic Brain Injury Patients. In Korean Journal of Neurotrauma (Vol. 19, Number 2, pp. 185–194). Korean Neurotraumatology Society. https://doi.org/10.13004/kjnt.2023.19.e19 DOI: https://doi.org/10.13004/kjnt.2023.19.e19
Dengler, B. A., Karam, O., Barthol, C. A., Chance, A., Snider, L. E., Mundy, C. M., Bounajem, M. T., Johnson, W. C., Maita, M. M., Mendez-Gomez, P. M., Seifi, A., & Hafeez, S. (2022). Ketamine Boluses Are Associated with a Reduction in Intracranial Pressure and an Increase in Cerebral Perfusion Pressure: A Retrospective Observational Study of Patients with Severe Traumatic Brain Injury. Critical Care Research and Practice, 2022. https://doi.org/10.1155/2022/3834165 DOI: https://doi.org/10.1155/2022/3834165
Gaither, J. B., Spaite, D. W., Bobrow, B. J., Barnhart, B., Chikani, V., Denninghoff, K. R., Bradley, G. H., Rice, A. D., Howard, J. T., Keim, S. M., & Hu, C. (2024). EMS Treatment Guidelines in Major Traumatic Brain Injury with Positive Pressure Ventilation. JAMA Surgery, 159(4), 363–372. https://doi.org/10.1001/jamasurg.2023.7155 DOI: https://doi.org/10.1001/jamasurg.2023.7155
Gravesteijn, B. Y., Sewalt, C. A., Stocchetti, N., Citerio, G., Ercole, A., Lingsma, H. F., von Steinbüchel, N., Steyerberg, E. W., Wilson, L., Maas, A. I. R., Menon, D. K., & Lecky, F. E. (2021). Prehospital Management of Traumatic Brain Injury across Europe: A CENTER-TBI Study. Prehospital Emergency Care, 25(5), 629–643. https://doi.org/10.1080/10903127.2020.1817210 DOI: https://doi.org/10.1080/10903127.2020.1817210
Hatfield, J., Soto, A. L., Kelly-Hedrick, M., Kaplan, S., Komisarow, J. M., Ohnuma, T., & Krishnamoorthy, V. (2024). Safety, Efficacy, and Clinical Outcomes of Dexmedetomidine for Sedation in Traumatic Brain Injury: A Scoping Review. In Journal of Neurosurgical Anesthesiology (Vol. 36, Number 2, pp. 101–108). Lippincott Williams and Wilkins. https://doi.org/10.1097/ANA.0000000000000907 DOI: https://doi.org/10.1097/ANA.0000000000000907
Hossain, I., Rostami, E., & Marklund, N. (2023). The management of severe traumatic brain injury in the initial postinjury hours - Current evidence and controversies. In Current Opinion in Critical Care (Vol. 29, Number 6, pp. 650–658). Lippincott Williams and Wilkins. https://doi.org/10.1097/MCC.0000000000001094 DOI: https://doi.org/10.1097/MCC.0000000000001094
Hyland, S. J., Pandya, P. A., Mei, C. J., & Yehsakul, D. C. (2022). Sugammadex to Facilitate Neurologic Assessment in Severely Brain-Injured Patients: Retrospective Analysis and Practical Guidance. Cureus. https://doi.org/10.7759/cureus.30466 DOI: https://doi.org/10.7759/cureus.30466
Koroki, T., Kotani, Y., Yaguchi, T., Shibata, T., Fujii, M., Fresilli, S., Tonai, M., Karumai, T., Lee, T. C., Landoni, G., & Hayashi, Y. (2024). Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis. Critical Care, 28(1). https://doi.org/10.1186/s13054-024-04831-4 DOI: https://doi.org/10.1186/s13054-024-04831-4
Kurni, M., Kaloria, N., Hazarika, A., Jain, K., Gupta, S. K., & Walia, R. (2023). Comparison of Midazolam and Propofol Infusion to Suppress Stress Response in Patients With Severe Traumatic Brain Injury: A Prospective, Randomized Controlled Trial. Korean Journal of Neurotrauma, 19(1), 70–81. https://doi.org/10.13004/kjnt.2023.19.e4 DOI: https://doi.org/10.13004/kjnt.2023.19.e4
Laws, J. C., Rakkar, J., Buttram, S. D. W., & Wolf, M. S. (2025). Analgesia, Sedation, and Neuromuscular Blockade in Pediatric Severe Traumatic Brain Injury: Secondary Analysis of the “Approaches and Decisions in Acute Pediatric TBI Trial” (ADAPT). Neurocritical Care, 43(3), 745–755. https://doi.org/10.1007/s12028-025-02336-8 DOI: https://doi.org/10.1007/s12028-025-02336-8
Lee, J. W., Wang, W., Rezk, A., Mohammed, A., Macabudbud, K., Englesakis, M., Lele, A., Zeiler, F. A., & Chowdhury, T. (2024). Hypotension and Adverse Outcomes in Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. JAMA Network Open, 7(11). https://doi.org/10.1001/jamanetworkopen.2024.44465 DOI: https://doi.org/10.1001/jamanetworkopen.2024.44465
Liu, S. Y., Kelly-Hedrick, M., Temkin, N., Barber, J., Komisarow, J., Hatfield, J., Ohnuma, T., Manley, G., Treggiari, M. M., Colton, K., Vavilala, M. S., Grandhi, R., Laskowitz, D. T., Mathew, J. P., Hernandez, A., James, M. L., Raghunathan, K., Goldstein, B., Markowitz, A., & Krishnamoorthy, V. (2024). Association of Early Dexmedetomidine Utilization With Clinical and Functional Outcomes Following Moderate-Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study. Critical Care Medicine, 52(4), 607–617. https://doi.org/10.1097/CCM.0000000000006106 DOI: https://doi.org/10.1097/CCM.0000000000006106
Maas, A. I. R., Menon, D. K., Manley, G. T., Abrams, M., Åkerlund, C., Andelic, N., Aries, M., Bashford, T., Bell, M. J., Bodien, Y. G., Brett, B. L., Büki, A., Chesnut, R. M., Citerio, G., Clark, D., Clasby, B., Cooper, D. J., Czeiter, E., Czosnyka, M., … Zemek, R. (2022). Traumatic brain injury: progress and challenges in prevention, clinical care, and research. In The Lancet Neurology (Vol. 21, Number 11, pp. 1004–1060). Elsevier Ltd. https://doi.org/10.1016/S1474-4422(22)00309-X DOI: https://doi.org/10.1016/S1474-4422(22)00309-X
Meyfroidt, G., Bouzat, P., Casaer, M. P., Chesnut, R., Hamada, S. R., Helbok, R., Hutchinson, P., Maas, A. I. R., Manley, G., Menon, D. K., Newcombe, V. F. J., Oddo, M., Robba, C., Shutter, L., Smith, M., Steyerberg, E. W., Stocchetti, N., Taccone, F. S., Wilson, L., … Citerio, G. (2022). Management of moderate to severe traumatic brain injury: an update for the intensivist. In Intensive Care Medicine (Vol. 48, Number 6, pp. 649–666). Springer Science and Business Media Deutschland GmbH. https://doi.org/10.1007/s00134-022-06702-4 DOI: https://doi.org/10.1007/s00134-022-06702-4
Price, J., Moncur, L., Lachowycz, K., Major, R., Sagi, L., McLachlan, S., Keeliher, C., Steel, A., Sherren, P. B., & Barnard, E. B. G. (2023a). Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 31(1). https://doi.org/10.1186/s13049-023-01091-z
Price, J., Moncur, L., Lachowycz, K., Major, R., Sagi, L., McLachlan, S., Keeliher, C., Steel, A., Sherren, P. B., & Barnard, E. B. G. (2023b). Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 31(1). https://doi.org/10.1186/s13049-023-01091-z DOI: https://doi.org/10.1186/s13049-023-01091-z
Qin, J., He, C., Chen, Z., Yan, S., & Ma, J. (2025). Effects of intravenous lignocaine on haemodynamic responses to laryngoscopy and tracheal intubation in adults under general anaesthesia: A systematic review and meta-analysis. Indian Journal of Anaesthesia, 69(8), 748–758. https://doi.org/10.4103/ija.ija_201_25 DOI: https://doi.org/10.4103/ija.ija_201_25
Sagi, L., Price, J., Lachowycz, K., Starr, Z., Major, R., Keeliher, C., Finbow, B., McLachlan, S., Moncur, L., Steel, A., Sherren, P. B., & Barnard, E. B. G. (2023). Critical hypertension in trauma patients following prehospital emergency anaesthesia: a multi-centre retrospective observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 31(1). https://doi.org/10.1186/s13049-023-01167-w DOI: https://doi.org/10.1186/s13049-023-01167-w
Von Hellmann, R., Maia, I. W. A., Driver, B. E., Dorn De Carvalho, J. M., Gerberi, D., Bellolio, F., & Oliveira J. e Silva, L. (2025). Effect of pretreatment opioids on hemodynamics during emergency intubations: a systematic review. In European Journal of Emergency Medicine (Vol. 32, Number 6, pp. 405–413). Lippincott Williams and Wilkins. https://doi.org/10.1097/MEJ.0000000000001259 DOI: https://doi.org/10.1097/MEJ.0000000000001259
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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Copyright (c) 2026 Gabriela Alexandra Segovia Torres, Carlos Augusto Tinitana Soto, Diego Darío Salazar Corrales, Silvia Katherine Machado Barrera, Sandra Del Rocio Morocho Imbacuan (Autor/a)
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
