Descripción de los cambios en la velocidad media de flujo sanguíneo cerebral en posición supino y sedente, en pacientes con hemorragia subaracnoidea aneurismática con vasoespasmo asintomático o sin vasoespasmo. Serie de casos
Date
2014
Type:
Artículo
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8
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ORCID:
Journal Title
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Volume Title
Publisher
Sociedad Médica de Santiago
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Abstract
Early mobilization in intensive care units (ICU) provides
respiratory, neurological and cardiovascular benefits in hospitalized patients.
However, the orthostatic effects of changing from a supine to a sitting position
may interfere with cerebral hemodynamics of patients with aneurysmal subarachnoid
hemorrhage (aSAH). Aim: To describe the changes in mean cerebral
blood flow velocity (MCBFV) in supine and sitting position, in adult patients
with aSAH, with asymptomatic vasospasm (AVS) or without vasospasm (VS)
at a neurosurgical ICU. Material and Methods: Descriptive case series study
in 21 patients with aSAH, both with and without VS. They were positioned in a
supine 30° position and then seated at the edge of bed for six minutes. MCBFV
was measured by transcranial Doppler (TCD), and hemodynamic variables
in both positions were registered. After this basal assessment and for 21 days
after the episode of SAH, patients were seated once a day and signs of VS were
recorded. Results: No significant changes in MCBFV or hemodynamic variables
were detected during position changes, except for an increase in heart rate in the
sitting position. No patient with AVS at the onset, had symptomatic VS during
the 21 days of follow up when patients were seated. Among patients with a normal
MCBFV at baseline, five patients (24%) had VS at a mean of three days
after the first time that they were seated on the edge of bed. Conclusions: Sitting
patients at the edge of the bed is a safe mobilization alternative for patients who
suffered aSAH who did not have VS or had AVS.
Description
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Citation
Revista Médica de Chile,July 2014, vol.142,p.1502-1509
Keywords
Blood Flow Velocity, Intracraneal, Subarachnoid Hemorrhage, Supine Position, Ultrasonography, Doppler, transcranial