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Introducción: El traumatismo craneoencefálico grave presenta una elevada incidencia en pacientes pediátricos. Es una importante causa de muerte y discapacidad. Sus causas más comunes en este grupo etario son los accidentes domésticos y de tránsito, caídas, violencia y actividades deportivas. Se realizó una revisión bibliográfica en julio y agosto de 2023 con un total de 38 bibliografías en idioma español, inglés y portugués en las bases de datos de SciElo, Elsevier, Pubmed y el motor de búsqueda Google Académico. Se consideró como criterio de selección aquella literatura publicada con mayor actualidad en concordancia con lo novedoso de esta enfermedad. Objetivo: Describir la craniectomía descompresiva como una alternativa a la hipertensión intracraneal pediátrica producida por traumatismo craneoencefálico grave. Desarrollo: Ante un traumatismo craneoencefálico grave, la presión intracraneal aumenta, lo que causa hipertensión intracraneal. Cuando esta hipertensión no se logra controlar, se convierte en refractaria, se requieren otros tratamientos más agresivos como la craniectomía descompresiva. Este procedimiento es invasivo, consiste en remover parte del cráneo para disminuir la presión dentro de la cavidad craneana. Conclusiones: Es necesario continuar los estudios de craniectomía descompresiva en el manejo de la hipertensión craneal pediátrica en la población infanto-juvenil, pues los estudios enfocados en ellos no abundan; estos constituyen una intervención de rescate. A pesar de los adelantos científicos, logros terapéuticos alcanzados y conocimientos de la hipertensión craneal pediátrica, se considera la craniectomía descompresiva como una elección terapéutica óptima, con una justa predicción y no brindarla cuando las opciones reales de éxito sean insuficientes(AU)

Introduction: Severe head trauma has a high incidence in pediatric patients. It is a major cause of death and disability. Its most common causes in this age group are domestic and traffic accidents, falls, violence and sports activities. A bibliographic review was carried out in July and August 2023 with a total of 38 bibliographies in Spanish, English and Portuguese from the SciElo, Elsevier, Pubmed databases and the Google Scholar search engine. The most recent published literature in accordance with the novelty of this disease was considered as a selection criterion. Objective: To describe decompressive craniectomy as an alternative to pediatric intracranial hypertension caused by severe head trauma. Development: In the event of severe head trauma, intracranial pressure increases, causing intracranial hypertension. When this hypertension cannot be controlled, it becomes refractory, other more aggressive treatments such as decompressive craniectomy are required. This procedure is invasive, it consists of removing part of the skull to reduce the pressure inside the cranial cavity. Conclusions: It is necessary to continue studies of decompressive craniectomy in the management of pediatric cranial hypertension in the child and adolescent population, since studies focused on them are not abundant; these constitute a rescue intervention. Despite scientific advances, therapeutic achievements and knowledge of pediatric cranial hypertension, decompressive craniectomy is considered an optimal therapeutic choice, with fair prediction and not provided when the real options for success are insufficient(AU)

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OBJECTIVE@#To summarize the research progress on the mechanism related to traumatic brain injury (TBI) to promote fracture healing, and to provide theoretical basis for clinical treatment of fracture non-union.@*METHODS@#The research literature on TBI to promote fracture healing at home and abroad was reviewed, the role of TBI in fracture healing was summarized from three aspects of nerves, body fluids, and immunity, to explore new ideas for the treatment of fracture non-union.@*RESULTS@#Numerous studies have shown that fracture healing is faster in patients with fracture combined with TBI than in patients with simple fracture. It is found that the expression of various cytokines and hormones in the body fluids of patients with fracture and TBI is significantly higher than that of patients with simple fracture, and the neurofactors released by the nervous system reaches the fracture site through the damaged blood-brain barrier, and the chemotaxis and aggregation of inflammatory cells and inflammatory factors at the fracture end of patients with combined TBI also differs significantly from those of patients with simple fracture. A complex network of humoral, neural, and immunomodulatory networks together promote regeneration of blood vessels at the fracture site, osteoblasts differentiation, and inhibition of osteoclasts activity.@*CONCLUSION@#TBI promotes fracture healing through a complex network of neural, humoral, and immunomodulatory, and can treat fracture non-union by intervening in the perifracture microenvironment.

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Introducción. Los traumatismos craneoencefálicos (TCE) son una causa frecuente de muerte y discapacidad alrededor del mundo. Objetivo. Describir la discapacidad, el funcionamiento, la depresión, la ansiedad y la calidad de vida en pacientes con TCE moderado o grave en los primeros 90 días luego de sufrir la lesión. Métodos. Estudio de corte transversal realizado con pacientes adultos que sufrieron un TCE moderado o grave en Medellín (Colombia) y su área metropolitana. Resultados. Se incluyeron 153 pacientes con TCE, 87 grave y 66 moderado. La causa más frecuente de la lesión fueron los accidentes de tránsito en motocicleta, la edad promedio de los participantes fue 48,3 (DE=19,4) años, 79,7% eran de sexo masculino y 46,4% estaban solteros. Al momento del trauma, 70,6% estaban bajo efecto de alcohol o sustancias psicoactivas y 44,4% trabajaban por su propia cuenta. En las imágenes diagnósticas tomadas en la fase aguda, la lesión observada con más frecuencia fue el hematoma subdural, en 43,79%. El funcionamiento fue peor en los pacientes con TCE grave evaluado tanto por la escala Disabilty Rating Scale (DRS) (8,79 vs. 3,82) como en todos los dominios del World Health Organization Disability Assessment Schedule (WHO-DAS II) (el más afectado fue el de Actividades fuera de la casa y el menos afectado, el de Relaciones interpersonales). En la función cognitiva, el puntaje promedio del Montreal Cognitive Assessment (MoCA) fue 16 (DE=8,9) en los pacientes con TCE grave y 20.2 (DE=6,9) en los de TCE moderado. La cali-dad de vida fue peor en los pacientes con TCE grave en todos los dominios, con peor percepción en el desempeño físico. La ansiedad de estado y la de rasgo fueron peores en los pacientes con TCE grave, aunque con diferencias no significativas. El dolor en la escala análoga visual fue mayor en quienes tuvieron TCE grave. Conclusiones. Los TCE son lesiones que pueden afectar a la población en edad productiva y generar secuelas de funcionamiento, dolor, ansiedad, depresión y cognitivas que impactan la calidad de vida, siendo estas consecuencias más graves en quienes sufren TCE graves en comparación con quienes tienen TCE moderados.

Introduction. Cranioencephalic traumatisms (CETs) are a common cause of death and disability worldwide. Objective. To describe the disability, functioning, depression, anxiety, and quality of life in patients with moderate or severe CET in the first 90 days after suffering the injury. Methods. Cross-sectional study conducted with adult patients who suffered a moderate or severe CET in Medellín (Colombia) and its metropolitan area. Results. 153 patients with CET, 87 severe and 66 moderate, were included. The most frequent cause of the injury was motorcycle traffic accidents, the mean age of the participants was 48.3 (SD=19.4) years, 79.7% were men and 46.4% were single. At the time of the trauma, 70.6% were under the influence of alcohol or psychoactive substances and 44.4% were working on their own. In the diagnostic images taken in the acute phase, the most frequently observed lesion was subdural hematoma, in 43.79%. Functioning was worse in patients with severe CET as assessed by both the Disability Rating Scale (DRS) (8.79 vs. 3.82) and in all domains of the World Health Organization Disability Assessment Schedule (WHO-DAS II) (the most affected domain was the one of Activities outside home and the least affected was Interperson-al relations). In the cognitive function, the average score in the Montreal Cognitive Assessment (MoCA) was 16 (SD=8.9) in patients with severe CET and 20.2 (SD=6.9) in those with moderate CET. The quality of life was worse in patients with severe CET in all domains, with a worse perception in physical performance. State and trait anxiety were worse in patients with severe CET, although with non-significant differences. Pain on the visual analogue scale was worse in those who had severe CET. Conclusions. CETs are injuries that can affect the population of productive age and generate pain, anxiety, depression, functioning and cognitive sequelae that impact quality of life, being these consequences more serious in those who suffer severe CETs compared with those with moderate CETs.

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Context and objective. Brain trauma is the first cause of death among young people and a quarter of victims develop an intracranial hematoma. The objective was to describe the socio-demographic, radiological, clinical and post-therapeutical aspects of patients treated for post-traumatic intracranial hematomas at Kinshasa University Hospital. Methods. This was an analytical series of traumatized patients with intracranial hematomas, followed at the Kinshasa University hospital from January 1999 to December 2019. Variables of interest included clinical, therapeutic, and post-therapeutic outcomes. The Pearson Chi-square test was used to compare proportions. Results. In a total of 269 patients, Subdural Hematoma predominated at 54.3%. Road accidents accounted for 57.6% of the etiologies. The median age was 37.3 years with male predominance. Among patients admitted for Extradural Hematoma, 27 (28.4 %) consulted beyond 24 hours. Intracranial hypertension signs were present in 57.5% of cases. The operating time was less than 24h for 12.4% of patients. Mortality was 10% and full recovery represents 61.3%. The adverse factors were age >60 years, mydriasis, polytrauma, Glasgow Coma Score ≤ 8. Conclusion. Post-traumatic intracranial hematomas are common in our environment. The admission period remains relatively long but the majority of patients fully recover.

Contexte et objectif. Les traumatismes crâniens représentent la 1ère cause de mortalité chez les jeunes et le quart de ces traumatisés développe les hématomes intracrâniens. L'objectif de la présente étude était de décrire les aspects sociodémographiques et radio-cliniques ainsi que l'évolution post-thérapeutique des patients traités pour hématomes intracrâniens post-traumatiques. Méthodes. Il s'agissait d'une série analytique des traumatisés avec hématomes intracrâniens, suivis aux Cliniques Universitaires de Kinshasa de janvier 1999 à décembre 2019. Les variables d'intérêt comprenaient les données cliniques, thérapeutiques ainsi que l'évolution post-thérapeutique. Nous avons utilisé le test de Chi-carré de Pearson pour comparer les proportions. Résultats. Sur un total de 269 patients, les hématomes sous-duraux prédominaient (54,3%). Les accidents des voies publiques ont constitué 57,6% des causes. L'âge médian global était de 37,3 ans avec une prédominance masculine. Vingt-sept patients (28,4 %) admis pour hématomes extraduraux ont consulté au-delà de 24h. Les signes d'hypertension intracrânienne étaient présents dans 57,5% des cas. Le délai opératoire général a été de moins de 24h pour 12,4% des cas. La mortalité était de 10 % et la récupération complète de 61,3 %. Les facteurs d'évolution défavorable étaient l'âge >60ans, la mydriase, le polytraumatisme, le score de Glasgow ≤ 8. Conclusion. Les hématomes intracrâniens post-traumatiques sont fréquents dans notre milieu. Le délai d'admission reste relativement long et la majorité d'entre eux récuperent complétement.

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Introducción: El traumatismo craneoencefálico (TCE) puede generar vértigo, mareo e inestabilidad. Posibles causas otorrinolaringológicas son el vértigo postural paroxístico benigno (VPPB) que constituye el diagnóstico más frecuente, y la hipofunción vestibular. Objetivo: Describir la prevalencia de hipofunción vestibular en un grupo de pacientes con VPPB asociado a TCE. Material y Método: Estudio retrospectivo de pacientes con VPPB asociado a TCE que requirieron maniobra de reposición (MRP) entre los años 2017 y 2021. La información clínica, características clínico-demográficas, hallazgos en pruebas de función vestibular y número de MRP fueron evaluados. Resultados: Se incluyeron 48 pacientes con una edad promedio de 60,8 ± 16,5 años, siendo un 52% mujeres. La prevalencia de pacientes con paresia vestibular concomitante correspondió al 35,4%. Al comparar al grupo con y sin paresia se observó: (1) en el grupo con paresia fue, significativamente, más frecuente presentar contusión cerebral asociada, 47,1% vs 12,9%; (2) el sexo masculino fue, significativamente, más frecuente en el grupo con paresia, 70,59% vs 35,5%; (3) en ambos grupos, la mediana de MRP fue 1. Conclusión: La presencia de paresia vestibular en pacientes con VPPB secundario a TCE, no es un hallazgo infrecuente, en nuestro estudio, correspondió a un 35,4%, siendo este más frecuente en hombres. Adicionalmente, la contusión cerebral asociada es más frecuente en el grupo con paresia.

Introduction: Head trauma can generate vertigo, dizziness and instability. Possible otorhinolaryngologic causes are benign paroxysmal postural vertigo (BPPV), which is the most frequent diagnosis, and vestibular hypofunction. Aim: To describe the prevalence of vestibular hypofunction in a group of patients with BPPV associated with head trauma. We studied the clinical characteristics, vestibular function test findings and the number of (PRM). Material and Method: Retrospective study of patients with BPPV associated with head trauma who underwent particle repositioning maneuvers (PRM) during the years 2017 to 2021. Clinical characteristics, vestibular function test findings and the number of PRM were evaluated. Results: 48 patents were included. The mean age was 60.8 ± 16.5 years old, 52% were women. The prevalence of patients with concomitant vestibular paresis was 35.4%. When comparing the groups with and without paresis the following was observed: (1) associated brain contusions were significatively more frequent in the paresis group, 47.1% vs 12.9%; (2) male sex was significatively more frequent in the paresis group, 70.59% vs 35.5%; (3) in both groups, the median of needed PRM was 1. Conclusion: The presence of vestibular paresis in patients with BPPV secondary to head trauma is not an infrequent finding. In our study, its prevalence was 35.4%, being significatively more frequent in men. Also, associated brain contusions were significatively more frequent in the paresis group.

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Introduction: In Brazil, traumatic brain injury (TBI) represents about two thirds of all causes of death and are often associated with traffic accidents, causing overload of medium and high complexity services. Objectives:To describe the occurrence and clinical-epidemiological profile of TBIs associated with traffic accidents in a regional hospital in the southeast of the state of Pará. Materials and Methods: This is a cross-sectional analytical study. It was based on data from the medical and statistical archives service of a regional hospital, through the analysis of electronic medical records of patients treated with TBI resulting from traffic accidents in the period from 2016 to 2020. Results: Of the 20,077 overall hospitalizations recorded, 4.0% were associated with the occurrence of TBI, of which, 75.3% were directly caused by traffic accidents involving motorcycles. The cases were concentrated in individuals of mixed race, male, aged between 18 and 29 years, with percentages of 92.5%, 86% and 39%, respectively. Conclusions: The occurrence of TBIs associated with automobile accidents is a problem that requires attention in the region. Moreover, there were several gaps in the completion of the medical records, which made it difficult to determine the association of the outcome, alcohol consumption and the use of PPE. However, considering all the information presented, assertive local public policies aimed at prevention can be implemented. And this can be the starting point for promoting changes aimed at mitigating traffic accidents and bed occupations due to preventable causes, impacting the quality of health care and economic factors (AU).

Introdução: No Brasil, os traumatismos cranioencefálicos (TCEs) representam cerca dois terços de todas as causas de óbitos e são frequentemente associados a acidentes de trânsito, causando sobrecarga dos serviços de média e alta complexidade. Objetivos: Descrever a ocorrência e o perfil clínico-epidemiológico de TCEs associados a acidentes de trânsito em um hospital regional no Sudeste do Estado do Pará. Materiais e Métodos: Trata-se de um estudo analítico de corte transversal. Baseou-se em dados provenientes do serviço de arquivos médicos e estatísticos de um hospital regional, através da análise de prontuários eletrônicos de pacientes diagnosticados com TCE decorrentes de acidentes de trânsito no período de 2016 a 2020. Resultados: Das 20.077 internações gerais re-gistradas, 4,0% foram associadas à ocorrência de TCE, das quais 75,3% foram diretamente causados por acidentes de trânsito envolvendo motocicletas. Os casos se concentraram em indivíduos pardos, do sexo masculino, com faixa etária entre 18 e 29 anos, com percentuais de 92,5%, 86% e 39%, respectivamente. Conclusões: A ocorrência de TCEs associados a acidentes automobilísticos é um problema que requer atenção na região. Além disso, verificou-se várias lacunas no preenchimento dos prontuários, o que dificultou a determinação da associação do desfecho, o consumo de álcool e a utilização dos EPIs. No entanto, considerando todas as informações apresentadas, políticas públicas assertivas locais que visem a prevenção podem ser implementadas. E esse pode ser o ponto de partida para promover mudanças que visem mitigação dos acidentes de trânsito e ocupações de leitos por causas evitáveis, impactando na qualidade da assistência em saúde e fatores econômicos (AU).

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INTRODUCCIÓN. La disección de aorta es una patología poco frecuente, cuando se presenta, lo hace de una manera catastrófica manifestada por dolor torácico o lumbar intenso acompañado de compromiso hemodinámico agudo, un diagnóstico y tratamiento temprano suelen ser cruciales para evitar la muerte del paciente, así mismo, una disección de aorta puede ser secundario a un trauma torácico por desaceleración y se presenta en 1,5% a 2%, lo que induce sobre todo a un desgarro localizado en la región del istmo aórtico. CASO CLÍNICO. Paciente masculino de 35 años, con antecedente de accidente en vehículo motorizado que provocó un traumatismo cráneo encefálico moderado, hematoma epidural parietal derecho, con resolución quirúrgica hace 18 meses, se descartó lesiones a nivel de tórax con radiografía de tórax normal, además se realizó ecografía FAST en ventana perihepática, suprapúbica, periesplénica y subxi-foidea sin encontrar alteración. Acudió al servicio de emergencia por un cuadro de hemiparesia derecha más disartria de 4 horas de evolución, se realiza tomografía de cráneo sin encontrarse lesión, catalogándose como evento cerebrovascular isquémico con recuperación neurológica. Durante su estancia hospitalaria presenta un cuadro de disnea de grandes esfuerzos y tras realizar exámenes complementarios de control se llega a una conclusión de una cardiomegalia, por lo que es referido a consulta de cardiología donde se realiza ecocardiograma, en la cual se observa disección de aorta ascendente más aneurisma por lo que se decide su ingreso y se instaura tratamiento mediante medidas de soporte, con derivación a hospital de especialidades para cirugía cardiotorácica. CONCLUSIONES. La disección de aorta secundario a un traumatis-mo es poco frecuente, sin embargo, el diagnostico siempre debe estar presente en caso de trauma por desaceleración, ya que es vital para la supervivencia del paciente y su manejo oportuno.

INTRODUCTION. Aortic dissection is an infrequent pathology; when it occurs, it does so in a catastrophic manner manifested by intense thoracic or lumbar pain accompanied by acute he-modynamic compromise. Early diagnosis and treatment are usually crucial to avoid the patient's death; likewise, aortic dissection can be secondary to thoracic trauma due to deceleration and occurs in 1.5% to 2%, which mainly induces a localized tear in the region of the aortic isthmus. CLINICAL CASE. 35-year-old male patient, with a history of motor vehicle accident that caused a moderate head injury, right parietal epidural hematoma, with surgical resolution 18 months ago, chest injuries were ruled out with normal chest X-ray, and FAST ultrasound was performed in perihepatic, suprapubic, perisplenic and subxiphoid window without finding any alteration. She went to the emergency department for a picture of right hemiparesis and dysarthria of 4 hours of evolution, a cranial tomography was performed without finding any lesion, being clas-sified as an ischemic cerebrovascular event with neurological recovery. During his hospital stay he presented with dyspnea of great effort and after performing complementary control tests, a cardiomegaly was found, so he is referred to a cardiology clinic where an echocardiogram is per-formed, which showed dissection of the ascending aorta plus aneurysm, admission is decided and treatment is instituted through supportive measures, with referral to a specialty hospital for cardiothoracic surgery. CONCLUSIONS. Aortic dissection secondary to trauma is rare, however, the diagnosis should always be present in case of trauma due to deceleration, as it is vital for the survival of the patient and its timely treatment.

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Introducción: el trauma craneoencefálico es una de las principales causas de morbimortalidad infantil en Colombia, sus secuelas impactan gravemente la calidad de vida de los pacientes y la evidencia científica actual de los factores asociados al trauma es escasa. Objetivo: analizar los factores asociados al desarrollo de secuelas por trauma craneoencefálico en menores de 15 años que consultaron a un hospital de Medellín entre 2010 y 2014. Materiales y métodos: estudio de cohorte retrospectivo. Se incluyeron 812 pacientes en un periodo de 5 años, de los cuales 294 no cumplieron los criterios de inclusión. Se evaluaron variables sociodemográficas, clínicas y se estimó la incidencia de secuelas con el método estadístico de Wilson. El riesgo relativo se calculó mediante regresión log-binomial. Resultados: en total se analizaron 518 pacientes. La mediana de edad fue de 5 años, el 64,3 % eran hombres, el 75,4 % de los participantes tenía un trauma leve y el 5 % un trauma grave. Las caídas fueron la principal causa (64,2 %), seguidas de los accidentes de tránsito (25,3 %). La incidencia de secuelas fue del 7.3 % (IC: 5,4 % - 9,9 %). Conclusiones: la carga de enfermedad en el paciente posterior a TCE representa un problema de salud pública. La probabilidad de desarrollar una secuela en este estudio fue del 7,3 %, la cual se relaciona con los siguientes factores que se identifican en el servicio de urgencias: lesión difusa, una escala de Glasgow al ingreso moderada o grave y sufrir un accidente de tránsito.

Background: traumatic brain injury is one of the main causes of infant morbidity and mortality. The sequelae after trauma seriously impact the quality of life of patients and the scientific evidence of associated factors is scarce. Objective: to analyze the factors associated with the development of sequelae due to head trauma in children under 15 years old who went to the emergency room of a hospital in Medellín between 2010 and 2014. Materials and methods: retrospective cohort study. 812 patients were included in a period of 5 years, of which 294 did not meet the inclusion criteria. Sociodemographic and clinical variables were evaluated and the incidence of sequelae was estimated with 95 % confidence intervals using the Wilson statistical method. The relative risk was calculated using log-binomial regression. Results: a total of 518 patients were analyzed. The median age was 5 years, 64,23 % were male children, 75,4 % had mild trauma, and 5 % suffered severe trauma. Falls were the main cause (64,2 %), followed by traffic accidents (25,3 %). The incidence of sequelae was 7,3 % (CI: 5,4% - 9,9 %). Conclusions: the burden of disease in the patient after TCE represents a public health problem. The probability of developing a sequel in this study was 7,3 %, which is related to the following factors that identify in the emergency department: diffuse injury, a moderate or severe Glasgow scale on admission, and suffering a traffic accident.

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Introducción: El neurotrauma es una condición que puede dar paso a una hipertensión intracraneana, situación que es muy grave. Los métodos diagnósticos de elección son los invasivos, aun así, los no invasivos y entre ellos la ecografía del nervio óptico, ofrecen muchísimas ventajas. Objetivo: Describir elementos esenciales de la ecografía de nervio óptico como método para diagnosticar hipertensión intracraneal en pacientes adultos con neurotrauma. Métodos: Se hizo una revisión de la literatura más reciente sin restricción lingüística o geográfica en las bases de datos PubMed y SciELO, se usaron términos afines al tema del artículo y se realizó una valoración crítica sobre la bibliografía consultada. Resultados: La literatura disponible sobre la ecografía del nervio óptico en la determinación de la hipertensión intracraneal es abundante y la mayoría apunta a sus beneficios como método no invasivo. La principal debilidad del mismo es que no es capaz de dar un valor exacto y esto se debe a que el valor normal del diámetro de la vaina del nervio óptico por cada persona puede variar significativamente. La proporción directa entre el diámetro de la vaina del nervio óptico y la presión intracraneal es un hecho que ningún autor intenta invalidar. Conclusiones: La ecografía del nervio óptico es un método seguro, accesible económicamente, no invasivo, fácil de usar y con un valor predictivo confiable para determinar la hipertensión intracraneal(AU)

Introduction: Neurotrauma is a condition that can lead to intracranial hypertension, which is a very serious situation. The diagnostic methods of choice are the invasive ones, even so, the non-invasive ones offer many advantages, the ultrasound of the optic nerve is among them. Objective: To describe essential elements of optic nerve ultrasound as a method to diagnose intracranial hypertension in adult patients with neurotrauma. Methods: A review of the most recent literature was made without linguistic or geographical restrictions in databases such as PubMed and SciELO, terms related to the theme of the manuscript were used. A critical assessment of the consulted bibliography was made. Results: The available literature on optic nerve ultrasound in the determination of intracranial hypertension is abundant and most points to the benefits as a non-invasive method. However, its main weakness lies in the fact that it is not capable of giving an exact value, due to the fact that the normal value of the diameter of the optic nerve sheath for each person can vary significantly. The direct relationship between optic nerve sheath diameter and intracranial pressure is a fact that no author attempts to invalidate. Conclusions: Optic nerve ultrasound is a safe, affordable, non-invasive, easy-to-use method with a reliable predictive value to determine intracranial hypertension(AU)

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Introducción: Los pacientes con fracturas de base de cráneo anterior post traumatismo encéfalo-craneano tienen alto riesgo de fístula de líquido céfalo-raquídeo por las fosas nasales. Es importante el manejo oportuno y apropiado, evitando así complicaciones; razón por la cual se desarrolló el "protocolo HP" para su tratamiento quirúrgico. Objetivo: Comunicar la utilidad del "protocolo HP" en el manejo de la fístula de líquido céfalo-raquídeo de la base de cráneo anterior. Materiales y métodos: Estudio transversal retrospectivo con pacientes ≥ 15 años con diagnóstico de fístula de líquido céfalo-raquídeo nasal post traumatismo encéfalo-craneano, desde 1/1/2016 hasta 31/8/2021 que ingresaron al hospital y requirieron cirugía de reparación, con 28 pacientes incluidos, el valor p ˂0,05 (estadísticamente significativo). Resultados: 96,4% hombres, mayoría adultos jóvenes con traumatismo encéfalo-craneano leve; 82,1% presentó fístula de líquido céfalo-raquídeo temprana. Todos requirieron reparación transcraneal frontal, en 67,9% fue bilateral. La reparación antes de los 7 días fue en el 39,3%, 7-21 días en 46,4% y después de 21 días en 14,3% de los casos. Uso de drenaje lumbar continuo: preoperatorio 10,7%, intraoperatorio 60,7%, postoperatorio 46,4%. En el 89,3% la ubicación de la fístula de líquido céfalo-raquídeo intra-quirúrgica fue congruente con la tomografía. Desde el 2020 se sistematizó el manejo de las fístula de líquido céfalo-raquídeo. La recurrencia fue de 10,7% antes del 2020 (posteriormente fue de 0%), asociándose con Glasgow bajo e inicio de fístula de líquido céfalo-raquídeo 7 días post traumatismo encéfalo-craneano (p˂0,05). Complicaciones encontradas: meningitis 28,6%, convulsión 25%, anosmia 14,3%, neumoencéfalo a tensión 7,1% y absceso 3,6%. Mortalidad por fístula de líquido céfalo-raquídeo: 3,6%. Curación 96,4%. Conclusiones: La aplicación del "Protocolo HP" tuvo resultados satisfactorios. La tasa de recurrencia postoperatoria de fístula de líquido céfalo-raquídeo nasal post traumatismo encéfalo-craneano fue 0%(AU)

Background: Patients with anterior skull base fractures after traumatic brain injury have a high risk of cerebrospinal fluid leak through the nostrils. Timely and appropriate management is important, avoiding complications. The "HP protocol" for surgical treatment was developed. Objectives: To communicate the utility of the "HP protocol" in the management of the anterior skull base cerebrospinal fluid leak. Methods: Retrospective cross-sectional study; patients ≥ 15 years old with a diagnosis of nasal cerebrospinal fluid leak after traumatic brain injury, who were admitted at the hospital from 1/1/2016 to 8/31/2021 and required surgery. Included 28 patients, p value ˂0.05 (statistically significant). Results: 96.4% men, mostly young adults with mild traumatic brain injury; 82.1% presented early cerebrospinal fluid leak. All required frontal transcranial repair, in 67.9% it was bilateral. Repair before 7 days was in 39.3%, 7-21 days in 46.4%, and after 21 days in 14.3%. Use of continuous lumbar drainage: preoperative 10.7%, intraoperative 60.7%, postoperative 46.4%. In 89.3%, the location of the intraoperative cerebrospinal fluid leak was consistent with the CT scan. Since 2020, the management of the cerebrospinal fluid leak was systematized. The recurrence was 10.7% before 2020; after it was 0% and associated with low Glasgow and onset of cerebrospinal fluid leak 7 days after traumatic brain injury (p<0.05). Complications: meningitis 28.6%, seizure 25%, anosmia 14.3%, high tension pneumocephalus 7.1% and abscess 3.6%. Cerebrospinal fluid leak mortality: 3.6%. Cure 96.4%. Conclusions: The application of the "HP Protocol" had satisfactory results. The post traumatic brain injury nasal cerebrospinal fluid leak recurrence rate was 0%

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OBJECTIVE@#To observe the awakening effect and safety of Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on consciousness disorder in children with early severe traumatic brain injury (STBI) based on western medicine treatment.@*METHODS@#A total of 62 children with STBI were randomly divided into an observation group (31 cases,1 case dropped off) and a control group (31 cases, 1 case dropped off). The control group was treated with routine rehabilitation therapy (6 times a week for 30 days), and intravenous drip of cattle encephalon glycoside and ignotin injection (once a day for 28 days). On the basis of the treatment in the control group, the observation group was treated with Xingnao Kaiqiao acupuncture at Neiguan (PC 6), Shuigou (GV 26), Yintang (GV 24+), Baihui (GV 20), Sanyinjiao (SP 6), Zusanli (ST 36), etc., and supplementary acupoints according to clinical symptoms, once a day, 6 times a week for 30 days. The scores of Glasgow coma scale (GCS), coma recovery scale-revised (CRS-R) and modified Barthel index (MBI) were observed before treatment and 10, 20 and 30 d into treatment. Electroencephalogram (EEG) grading before and after treatment was observed in the two groups, and safety was evaluated.@*RESULTS@#After 10, 20 and 30 days of treatment, the scores of GCS, CRS-R and MBI in the two groups were increased compared before treatment (P<0.05), and those in the observation group were higher than the control group (P<0.05). After treatment, EEG grading of both groups was improved compared with that before treatment (P<0.05), and the observation group was better than the control group (P<0.05). There were no adverse events or adverse reactions in the two groups during treatment.@*CONCLUSION@#On the basis of western medicine treatment, Xingnao Kaiqiao acupuncture plays a remarkable role in wakening the early STBI children, can improve the level of consciousness disorder and daily living ability, and it is safe and effective.

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OBJECTIVE@#To investigate the effect of hydrogen gas on NOD-like receptor protein 3 (NLRP3) inflammasomes in the cerebral cortex of rats with traumatic brain injury (TBI).@*METHODS@#120 adult male Sprague-Dawley (SD) rates were randomly divided into 5 groups (n = 24): sham operation group (S group), TBI model group (T group), TBI+NLRP3 inhibitor MCC950 group (T+M group), TBI+hydrogen gas group (T+H group), TBI+hydrogen gas+MCC950 group (T+H+M group). TBI model was established by controlled cortical impact. NLRP3 inhibitor MCC950 (10 mg/kg) was intraperitoneally injected for 14 consecutive days before TBI operation in T+M and T+H+M groups. 2% hydrogen inhalation was given for 1 hour at 1 hour and 3 hours after TBI operation in T+H and T+H+M groups. At 6 hours after TBI operation, the pericontusional cortex tissues were obtained, the content of Evans blue (EB) was detected to evaluate the permeability of the blood-brain barrier. Water content in brain tissue was detected. The cell apoptosis was detected by TdT-mediated dUTP nick end labeling (TUNEL) and the neuronal apoptosis index was calculated. The expressions of Bcl-2, Bax, NLRP3, apoptosis-associated speck-like protein containing CARD (ASC) and caspase-1 p20 were detected by Western blotting. The levels of interleukins (IL-1β, IL-18) were detected by enzyme-linked immunosorbent assay (ELISA).@*RESULTS@#Compared with the S group, the content of EB in cerebral cortex, water content in brain tissue, apoptosis index and the expressions of Bax, NLRP3, ASC, caspase-1 p20 in T group were significantly increased, the expression of Bcl-2 was down-regulated, the levels of IL-1β and IL-18 were increased [the content of EB (μg/g): 87.57±6.89 vs. 10.54±1.15, water content in brain tissues: (83.79±2.74)% vs. (74.50±1.19)%, apoptotic index: (62.66±5.33)% vs. (4.61±0.96)%, Bax/β-actin: 4.20±0.44 vs. 1, NLRP3/β-actin: 3.55±0.31 vs. 1, ASC/β-actin: 3.10±0.26 vs. 1, caspase-1 p20/β-actin: 3.28±0.24 vs. 1, Bcl-2/β-actin: 0.23±0.03 vs. 1, IL-1β (ng/g): 221.58±19.15 vs. 27.15±3.27, IL-18 (ng/g): 87.26±7.17 vs. 12.10±1.85, all P < 0.05]. Compared with the T group, the T+M, T+H and T+H+M groups had significant reductions in the content of EB and water content in brain tissue, apoptotic index of the cerebral cortex, the expressions of Bax, NLRP3, and caspase-1 p20 in the brain tissue and the levels of IL-1β and IL-18, significant increases in the expression of Bcl-2. However, there was no significant difference in ASC expression. Compared with the T+H group, the content of EB in the cerebral cortex, water content in brain tissue, and apoptotic index, and the expressions of Bax, NLRP3 and caspase-1 p20 were further down-regulated in T+H+M group, the expression of Bcl-2 was further up-regulated, the levels of IL-1β and IL-18 were further decreased [the content of EB (μg/g): 40.49±3.15 vs. 51.96±4.69, water content in brain tissue: (76.58±1.04)% vs. (78.76±1.16)%, apoptotic index: (32.22±3.44)% vs. (38.54±3.89)%, Bax/β-actin: 1.92±0.16 vs. 2.56±0.21, NLRP3/β-actin: 1.94±0.14 vs. 2.37±0.24, caspase-1 p20/β-actin: 1.97±0.17 vs. 2.31±0.19, Bcl-2/β-actin: 0.82±0.07 vs. 0.52±0.04, IL-1β (ng/g): 86.23±7.09 vs. 110.44±10.48, IL-18 (ng/g): 40.18±3.22 vs. 46.23±4.02, all P < 0.05], but there were no statistical significance in all the indicators between T+M group and T+H group.@*CONCLUSIONS@#The mechanism by which hydrogen gas alleviates TBI may be related to inhibiting NLRP3 inflammasomes in the cerebral cortex of rats.

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OBJECTIVE@#To evaluate whether electroacupuncture (EA) would improve gastrointestinal function and clinical prognosis in patients with severe traumatic brain injury (TBI) complicocted by acute gastrointestinal injury (AGI).@*METHODS@#This multicenter, single-blind trial included patients with TBI and AGI admitted to 5 Chinese hospitals from September 2018 to December 2019. A total of 500 patients were randomized to the control or acupuncture groups using a random number table, 250 cases in each group. Patients in the control group received conventional treatment, including mannitol, nutritional support, epilepsy and infection prevention, and maintenance of water, electrolytes, and acid-base balance. While patients in the acupuncture group received EA intervention at bilateral Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Tianshu (ST 25), and Zhongwan (RN 12) acupoints in addition to the conventional treatment, 30 min per time, twice daily, for 7 d. The primary endpoint was 28-d mortality. The secondary endpoints were serum levels of D-lactic acid (D-lac), diamine oxidase (DAO), lipopolysaccharide (LPS), motilin (MTL) and gastrin (GAS), intra-abdominal pressure (IAP), bowel sounds, abdominal circumference, AGI grade, scores of gastrointestinal failure (GIF), Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), and Multiple Organ Dysfunction Syndrome (MODS), mechanical ventilation time, intense care unit (ICU) stay, and the incidence of hospital-acquired pneumonia.@*RESULTS@#The 28-d mortality in the acupuncture group was lower than that in the control group (22.80% vs. 33.20%, P<0.05). Compared with the control group, the acupuncture group at 7 d showed lower GIF, APACHE II, SOFA, MODS scores, D-lac, DAO, LPS, IAP, and abdominal circumference and higher GCS score, MTL, GAS, and bowel sound frequency (all P<0.05). In addition, the above indices showed simillar changes at 7 d compared with days 1 and 3 (all P<0.05) in the EA group.@*CONCLUSION@#Early EA can improve gastrointestinal function and clinical prognosis in patients with severe TBI complicated by AGI. (Registration No. ChiCTR2000032276).

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PURPOSE@#Despite advances in modern medicine, traumatic brain injuries (TBIs) are still a major medical problem. Early diagnosis of TBI is crucial for clinical decision-making and prognosis. This study aims to compare the predictive value of Helsinki, Rotterdam, and Stockholm CT scores in predicting the 6-month outcomes in blunt TBI patients.@*METHODS@#This cohort study was conducted on blunt TBI patients of 15 years or older. All of them were admitted to the surgical emergency department of Shahid Beheshti Hospital in Kashan, Iran from 2020 to 2021 and had abnormal trauma-related findings on brain CT images. The patients' demographic data such as age, gender, history of comorbid conditions, mechanism of trauma, Glasgow coma scale, CT images, length of hospital stay, and surgical procedures were recorded. The Helsinki, Rotterdam, and Stockholm CT scores were simultaneously determined according to the existing guidelines. The included patients' 6-month outcome was determined using the Glasgow outcome scale extended. M Data were analyzed by SPSS software version 16.0. Sensitivity, specificity, negative/positive predictive value and the area under the receiver operating characteristic curve were calculated for each test. The Kappa agreement coefficient and Kuder Richardson-20 were used to compare the scoring systems.@*RESULTS@#Altogether 171 TBI patients met the inclusion and exclusion criteria, with the mean age of (44.9 ± 20.2) years. Most patients were male (80.7%), had traffic related injuries (83.1%) and mild TBIs (64.3%). Patients with lower Glasgow coma scale had higher Helsinki, Rotterdam, and Stockholm CT scores and lower Glasgow outcome scale extended scores. Among all the scoring systems, the Helsinki and Stockholm scores showed the highest agreement in predicting patients' outcomes (kappa = 0.657, p < 0.001). The Rotterdam scoring system had the highest sensitivity (90.1%) in predicting death of TBI patients, whereas the Helsinki scoring system had the highest sensitivity (89.8%) in predicting the 6-month outcome in TBI patients.@*CONCLUSION@#The Rotterdam scoring system was superior in predicting death in TBI patients, whereas the Helsinki scoring system was more sensitive in predicting the 6-month outcome.

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OBJECTIVES@#To study the effect of early use of sodium valproate on neuroinflammation after traumatic brain injury (TBI).@*METHODS@#A total of 45 children who visited in Xuzhou Children's Hospital Affiliated to Xuzhou Medical University from August 2021 to August 2022 were enrolled in this prospective study, among whom 15 healthy children served as the healthy control group, and 30 children with TBI were divided into a sodium valproate treatment group and a conventional treatment group using a random number table (n=15 each). The children in the sodium valproate treatment group were given sodium valproate in addition to conventional treatment, and those in the conventional group were given an equal volume of 5% glucose solution in addition to conventional treatment. The serum concentrations of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3), high-mobility group box 1 (HMGB1), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β) were measured in the healthy control group on the day of physical examination and in the children with TBI on days 1, 3, and 5 after admission. Glasgow Outcome Scale-Extended (GOS-E) score was evaluated for the children with TBI 2 months after discharge.@*RESULTS@#Compared with the healthy control group, the children with TBI had significantly higher serum concentrations of NLRP3, HMGB1, TNF-α, and IL-1β on day 1 after admission (P<0.017). The concentration of NLRP3 on day 5 after admission was significantly higher than that on days 1 and 3 after admission in the children with TBI (P<0.017). On days 3 and 5 after admission, the sodium valproate treatment group had a significantly lower concentration of NLRP3 than the conventional treatment group (P<0.05). For the conventional treatment group, there was no significant difference in the concentration of HMGB1 on days 1, 3, and 5 after admission (P>0.017), while for the sodium valproate treatment group, the concentration of HMGB1 on day 5 after admission was significantly lower than that on days 1 and 3 after admission (P<0.017). On day 5 after admission, the sodium valproate treatment group had a significantly lower concentration of HMGB1 than the conventional treatment group (P<0.05). For the children with TBI, the concentration of TNF-α on day 1 after admission was significantly lower than that on days 3 and 5 after admission (P<0.017). On days 3 and 5 after admission, the sodium valproate treatment group had a significantly lower concentration of TNF-α than the conventional treatment group (P<0.05). The concentration of IL-1β on day 3 after admission was significantly lower than that on days 1 and 5 after admission (P<0.017) in the children with TBI. On days 3 and 5 after admission, the sodium valproate treatment group had a significantly lower concentration of IL-1β than the conventional treatment group (P<0.05). The GOS-E score was significantly higher in the sodium valproate treatment group than that in the conventional treatment group 2 months after discharge (P<0.05).@*CONCLUSIONS@#Early use of sodium valproate can reduce the release of neuroinflammatory factors and improve the prognosis of children with TBI.

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OBJECTIVES@#To investigate the characteristics and objective assessment method of visual field defects caused by optic chiasm and its posterior visual pathway injury.@*METHODS@#Typical cases of visual field defects caused by injuries to the optic chiasm, optic tracts, optic radiations, and visual cortex were selected. Visual field examinations, visual evoked potential (VEP) and multifocal visual evolved potential (mfVEP) measurements, craniocerebral CT/MRI, and retinal optical coherence tomography (OCT) were performed, respectively, and the aforementioned visual electrophysiological and neuroimaging indicators were analyzed comprehensively.@*RESULTS@#The electrophysiological manifestations of visual field defects caused by optic chiasm injuries were bitemporal hemianopsia mfVEP abnormalities. The visual field defects caused by optic tract, optic radiation, and visual cortex injuries were all manifested homonymous hemianopsia mfVEP abnormalities contralateral to the lesion. Mild relative afferent pupil disorder (RAPD) and characteristic optic nerve atrophy were observed in hemianopsia patients with optic tract injuries, but not in patients with optic radiation or visual cortex injuries. Neuroimaging could provide morphological evidence of damages to the optic chiasm and its posterior visual pathway.@*CONCLUSIONS@#Visual field defects caused by optic chiasm, optic tract, optic radiation, and visual cortex injuries have their respective characteristics. The combined application of mfVEP and static visual field measurements, in combination with neuroimaging, can maximize the assessment of the location and degree of visual pathway damage, providing an effective scheme for the identification of such injuries.

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A IV Jornada Científica Integrativa da Agir (Associação de Gestão, Inovação e Resultados em Saúde), apresenta o compilado de 9 resumos apresentando pesquisas e experiências práticas que contribuem significativamente para o avanço do conhecimento científico e para aprimorar a qualidade dos serviços de saúde, aborda os temas: Implantação de política institucional para o gerenciamento do cuidado em unidades de saúde; Agir digital: gestão da mudança e resolução da demanda de acesso aos serviços de saúde em unidades geridas em Rede; Disponibilização do pts em display beira-leito como medida de cuidado compartilhado e melhoria da qualidade da jornada do Paciente internado; Promovendo a saúde do colaborador através da gestão Data Driven: relatos de uma abordagem baseada em dados; Correlação entre nível de atividade física prévio a lesão medular espinhal e letramento em saúde em sujeitos internados em um centro de reabilitação; Avaliação neuropsicológica dos transtornos do neurodesenvolvimento no Sistema Único de Saúde: um relato de experiência na Residência Multiprofissional em Psicologia; Gestão baseada em evidências: a chave para a qualidade na saúde; e Disfunção executiva em pacientes com traumatismo cranioencefálico atendidos em um hospital de reabilitação: dados preliminares

The IV Integrative Scientific Conference of Agir (Association for Management, Innovation and Results in Health), presents a compilation of 9 abstracts presenting research and practical experiences that contribute significantly to the advancement of scientific knowledge and to improving the quality of health services, and addresses the following topics: Implementation of institutional policy for managing care in health units; Digital action: managing change and resolving the demand for access to health services in units managed in a Network; Provision of pts on bedside displays as a measure of shared care and improving the quality of the inpatient journey; Promoting employee health through Data Driven management: reports of a data-based approach; Correlation between the level of physical activity prior to spinal cord injury and health literacy in individuals admitted to a rehabilitation center; Neuropsychological assessment of neurodevelopmental disorders in the Unified Health System: an experience report in the Multidisciplinary Residency in Psychology; Evidence-based management: the key to quality in health; and Executive dysfunction in patients with traumatic brain injury treated at a rehabilitation hospital: preliminary data

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Objetivo La participación social es el acto de involucrarse en actividades que proporcionan interacciones con otras personas, y puede verse afectada en personas que han sufrido un traumatismo craneoencefálico (TCE). Este trabajo propone identificar qué factores influyen en dicha afectación. Método. Se realizó una revisión sistemática de artículos disponibles en PubMed, EBSCO y SCOPUS, publicados desde 2010 hasta 2020. Resultados. Los artículos revisados concuerdan que la participación social de los pacientes adultos con TCE se ve afectada por las siguientes variables: síntomas depresivos, edad, nivel educativo, alteraciones cognitivas y calidad de vida. Finalmente, se observó que la evaluación de la participación social está focalizada en la frecuencia con que los pacientes realizan actividades sociales y no indagan en la satisfacción personal con el nivel de participación.

Objective. Social participation is the act of getting involved in activities that provide interactions with other people and can be impaired in individuals who suffered a traumatic brain injury (TBI). This study aims to identify which factors influence social participation after TBI. Method. A systematic review of articles available in PubMed, EBSCO, and SCOPUS, published from 2010 to 2020 was conducted. Results. Revised articles conclude that social participation in adult patients with TBI is affected by the following variables: depressive symptoms, age, educational level, cognitive impairment, and quality of life. Finally, the focus of the assessment of social participation was the frequency with patients carrying out social activities and not the personal satisfaction with their level of participation.

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A tomografia computadorizada (TC) é exame de escolha para rastreamento de lesões no traumatismo cranioencefálico (TCE). Apesar disso, seu uso rotineiro no TCE leve é controverso O objetivo desta revisão foi avaliar o impacto da aplicação de diretrizes de manejo e conduta de TCE leve quanto à solicitação de TC de crânio. É busca realizada nas bases de dados LILACS, Medline, PubMed, SciELO, utilizando descritores do MeSH e DeCS. A busca inicial identificou 30.191 artigos. Após remoção de publicações duplicadas, seleção pelo título, seleção pelo resumo, restaram 25 publicações, que foram lidas na íntegra e cinco incluídas na presente revisão sistemática. Em conclusão, os artigos analisados apresentaram, em média, redução de 25,8% na solicitação de TC de crânio quando aplicadas as diretrizes, e orientam que protocolos para TCE leve são ferramentas eficientes para auxiliar a prática médica, impactando positivamente quando aplicados na população, devendo sempre ser levado em conta a avaliação clínica.

Computed tomography (CT) is the exam of choice for tracking injuries in traumatic brain injury (TBI). Despite this, its routine use in mild TBI is controversial. The objective of this review was to evaluate the impact of applying guidelines for the management and conduct of mild TBI on the request for CT of the head. A search was carried out in the LILACS, Medline, PubMed, SciELO databases, using MeSH and DeCS descriptors. The initial search identified 30,191 articles. After removal of duplicate publications, selection by title, selection by abstract, 25 publications remained, which were read in full and five were included in this systematic review. In conclusion, the articles analyzed showed, on average, a 25.8% reduction in the request for cranial CT when the guidelines were applied, and guide that protocols for mild TBI are efficient tools to assist medical practice, positively impacting when applied to the population. , and clinical evaluation should always be taken into account.

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INTRODUCTION: Several studies have shown that early mobilization is safe and beneficial for patients admitted to the intensive care units (ICUs), especially for those with mechanical ventilation (MV). OBJECTIVE: To investigate the benefits of early mobilization physiotherapeutic techniques applied to patients who suffered craniocerebral trauma (CCT). METHODS: This is an experimental study that evaluated clinical data from 27 patients. In sedated patients, mobilization and passive stretching were performed on the upper and lower limbs; in those without sedation, active-assisted, free and resisted exercises were included. RESULTS: The experimental group was composed of 51.8% of the participants and the control group by 48.2%, the majority being male (81.5%) with a median age of 43 years. The patients in the experimental group had an average of 9.5 days (2.2-14.7) of mechanical ventilation (MV), and those belonging to the control group, of 17 days (7-21.7) with MV (p=0.154). The patients in the experimental group had an average of 13.5 days in the ICU, against an average of 17 days in the control group (p=0.331), and an average of 20.5 days in hospital against 24 days in the control group (p=0.356). CONCLUSION: Early mobilization should be applied to critically ill patients as it can decrease the length of stay in the ICU and the hospital.

INTRODUÇÃO: Diversos estudos têm mostrado que a mobilização precoce é segura e benéfica para pacientes internados em unidades de terapia intensiva (UTIs), especialmente para aqueles com ventilação mecânica (VM). OBJETIVO: Investigar os benefícios das técnicas fisioterapêuticas de mobilização precoce aplicada aos pacientes que sofreram traumatismo cranioencefálico (TCE). MÉTODOS: Trata-se de um estudo quasi-randomizado, que incluiu 27 com TCE divididos em dois grupos: controle (n=13) e experimental (n=14) pacientes. No grupo experimental, os pacientes sedados foram submetidos à mobilização e alongamentos passivos nos membros superiores e inferiores; naqueles sem sedação, foram incluídos exercícios ativo-assistidos, livres e resistidos. RESULTADOS: O grupo experimental foi composto por 51,8% dos participantes da pesquisa e o grupo controle por 48,2%, sendo a maioria do sexo masculino (81,5%) com mediana de idade de 43 anos. Os pacientes do grupo experimental apresentaram média de 9,5 dias (2,2-14,7) de ventilação mecânica, e os pertencentes ao grupo controle, de 17 dias (7-21,7) com de VM (p=0,154). Os pacientes do grupo experimental apresentaram média de 13,5 dias de internação em UTI, contra média de 17 dias do grupo controle (p=0,331), e média de 20,5 dias de internação hospitalar contra 24 dias do grupo controle (p=0,356). CONCLUSÃO: A mobilização precoce é uma técnica que deve ser aplicada em pacientes críticos dentro das UTIs, pois pode diminuir o tempo de internação na UTI e hospitalar.