ABSTRACT
Durante la resucitación cardiopulmonar y tras la recuperación de la circulación espontánea, una perfusión tisular efectiva determina el pronóstico final. La ultranosografía Doppler transcraneal (DTC) registra la velocidad y la pulsatilidad del flujo sanguíneo cerebral y permite realizar análisis hemodinámicos «latido a latido». Durante la resucitación cardiopulmonar la velocidad sistólica máxima alcanzada refleja la perfusión cerebral en cada compresión torácica. Tras la recuperación de la circulación espontánea, la persistencia después de 2h de un patrón arterial cerebral hipodinámico (baja velocidad media y alta pulsatilidad en la DTC) pronostica mala recuperación neurológica. La presencia, precoz o tardía, de un patrón de DTC hiperémico (alta velocidad media y baja pulsatilidad) se asocia a mal pronóstico por evolución a hipertensión intracraneal; su aparición durante la fase de recalentamiento debería llevar a reinstaurar la hipotermia terapéutica La coincidencia de arterias con patrones hipodinámicos con otras normales o hiperdinámicas indica focos de hipoperfusión que son predictores de ictus (AU)
An effective tissue perfusion has decisive influence on the final prognosis both during cardiopulmonary resuscitation (CPR) and after recovery of spontaneous circulation (ROSC). The transcranial Doppler ultranosography (TCD) examines the velocity and pulsatility of cerebral blood flow, making it possible to perform "beat to beat" hemodynamic analysis. During CPR, TCD peak systolic velocity reflects cerebral perfusion of the chest compressions. Beyond 2 hours after ROSC, persistence in the cerebral arteries of a hemodynamic TCD pattern (low velocities with high pulsatilities) predicts poor neurological prognosis. Early or delayed presence of a hyperemic TCD pattern (high velocities with low pulsatilities) is associated conclusively with evolution to intracranial hypertension and its appearance during the rewarming process should lead to immediate return to therapeutic hypothermia. The coincidence of hypodynamic cerebral arteries and others with normal or hyperemic TCD patterns may indicate the presence of focal hypoperfusion that could predict stroke after ROSC (AU)
Subject(s)
Humans , Ultrasonography, Doppler, Transcranial/methods , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Stroke/prevention & control , Prehospital Care , HemodynamicsABSTRACT
An effective tissue perfusion has decisive influence on the final prognosis both during cardiopulmonary resuscitation (CPR) and after recovery of spontaneous circulation (ROSC). The transcranial Doppler ultranosography (TCD) examines the velocity and pulsatility of cerebral blood flow, making it possible to perform "beat to beat" hemodynamic analysis. During CPR, TCD peak systolic velocity reflects cerebral perfusion of the chest compressions. Beyond 2 hours after ROSC, persistence in the cerebral arteries of a hemodynamic TCD pattern (low velocities with high pulsatilities) predicts poor neurological prognosis. Early or delayed presence of a hyperemic TCD pattern (high velocities with low pulsatilities) is associated conclusively with evolution to intracranial hypertension and its appearance during the rewarming process should lead to immediate return to therapeutic hypothermia. The coincidence of hypodynamic cerebral arteries and others with normal or hyperemic TCD patterns may indicate the presence of focal hypoperfusion that could predict stroke after ROSC.
Subject(s)
Cardiopulmonary Resuscitation/methods , Cerebrovascular Circulation , Heart Arrest/therapy , Hypoxia-Ischemia, Brain/diagnostic imaging , Ultrasonography, Doppler, Transcranial , Brain Damage, Chronic/diagnostic imaging , Brain Damage, Chronic/physiopathology , Brain Damage, Chronic/prevention & control , Coma/etiology , Critical Care/methods , Heart Arrest/complications , Heart Massage , Humans , Hypoxia-Ischemia, Brain/etiology , Hypoxia-Ischemia, Brain/physiopathology , Pulsatile Flow , Systole , Time FactorsABSTRACT
A higher prevalence of cardiac right-to-left shunt through a patent foramen ovale (PFO) has been recently reported in the irritable bowel syndrome (IBS). At the same time, signs of ischemia in medullary cerebral microcirculation and the presence of excess sympathetic activity in peripheral circulation have been identified, both related with change in pain perception and autonomic dysfunction characteristic of IBS. Considering these findings together, the possible etiopathogenic role of PFO in the development of IBS can be proposed, because the paradoxical embolism characteristic of PFO could damage the cerebral and intestinal microcirculation, and that injury would be also amplified by the percentage of venous blood that shunts the pulmonary filter, producing an alteration in the metabolism of serotonin, pro-inflammatory bradykinins or neurotensin, substances with a proven etiopathogenic relationship with IBS.
Subject(s)
Foramen Ovale, Patent/complications , Irritable Bowel Syndrome/etiology , HumansABSTRACT
We present the case of a 64-year old woman with shock related to ischemic colitis associated with paradoxical embolism through a foramen ovale. Some utilities of transcranial Doppler ultra-sonography applied in this case that could have an usual interest in intensive and intermediate care are discussed. These include analysis of the regional distribution of cerebral blood flow, intracranial arterial continuous monitoring for detection of spontaneous microembolisms and injection of microbubbles to detect right to left shunts. The added value of using power M-mode Doppler in transcranial Doppler evaluations is highlighted.
Subject(s)
Critical Care/methods , Ultrasonography, Doppler, Transcranial , Female , Humans , Intensive Care Units , Middle AgedABSTRACT
Se presenta el caso de una mujer de 64 años con shock por colitis isquémica en relación con embolia paradójica a través de un foramen oval permeable. Se comentan algunas utilidades del Doppler transcraneal empleadas en este caso que podrían tener interés habitual en cuidados intensivos e intermedios. Éstas incluyen el análisis de la distribución regional del flujo sanguíneo cerebral, la monitorización arterial intracraneal para detección de microembolias espontáneas o la inyección de microburbujas para detección de cortocircuito derecha-izquierda. Se destaca el valor añadido aportado por la incorporación del Doppler modo M a la ultrasonografía Doppler transcraneal (AU)
We present the case of a 64-year old woman with shock related to ischemic colitis associated with paradoxical embolism through a foramen ovale. Some utilities of transcranial Doppler ultra-sonography applied in this case that could have an usual interest in intensive and intermediate care are discussed. These include analysis of the regional distribution of cerebral blood flow, intracranial arterial continuous monitoring for detection of spontaneous microembolisms and injection of microbubbles to detect right to left shunts. The added value of using power M-mode Doppler in transcranial Doppler evaluations is highlighted (AU)
Subject(s)
Humans , Female , Middle Aged , Ultrasonography, Doppler, Transcranial , Colitis, Ischemic/complications , Foramen Ovale, Patent , Colonoscopy , Migraine Disorders/etiologyABSTRACT
En el síndrome de intestino irritable (SII) ha sido observada recientemente una mayor prevalencia de cortocircuito de derecha a izquierda cardíaco por foramen oval permeable (FOP). Paralelamente se han identificado signos de isquemia en la microcirculación cerebral a nivel bulbar y de exceso de actividad simpática en la circulación periférica, relacionables ambos con la alteración en la percepción del dolor y la disfunción autonómica características del SII. Sumando estos hallazgos, puede plantearse una posible contribución etiopatogénica del FOP al desarrollo de SII, basada en que la embolización paradójica característica del FOP podría alterar la microcirculación (cerebral, intestinal, periférica, etc.) que se vería además potenciada por el porcentaje de sangre venosa que elude el filtro pulmonar produciendo una alteración en el metabolismo de la serotonina, las bradiquininas proinflamatorias y la neurotensina, sustancias de probada relación etiopatogénica con el SII (AU)
A higher prevalence of cardiac right-to-left shunt through a pateA higher prevalence of cardiac right-to-left shunt through a patent foramen ovale (PFO) has been recently reported in the irritable bowel syndrome (IBS). At the same time, signs of ischemia in medullary cerebral microcirculation and the presence of excess sympathetic activity in peripheral circulation have been identified, both related with change in pain perception and autonomic dysfunction characteristic of IBS. Considering these findings together, the possible etiopathogenic role of PFO in the development of IBS can be proposed, because the paradoxical embolism characteristic of PFO could damage the cerebral and intestinal microcirculation, and that injury would be also amplified by the percentage of venous blood that shunts the pulmonary filter, producing an alteration in the metabolism of serotonin, pro-inflammatory bradykinins or neurotensin, substances with a proven etiopathogenic relationship with IBS (AU)
Subject(s)
Humans , Male , Female , Foramen Ovale, Patent/complications , Irritable Bowel Syndrome/etiology , Irritable Bowel Syndrome/physiopathology , Serotonin/metabolismABSTRACT
A frequent finding in healthy individuals, patent foramen ovale (PFO) with right-to-left shunt (RLSh), is an embrionary residue that has been linked with cryptogenic stroke and peripheral ischemia. Pulmonary hypertension and entities like decompression illness, migraine with aura or plathypnea-orthodeoxia have been found to have a higher prevalence of PFO with RLSh. Some dementias and unexplained syncopes could also have some relationship. Paradoxical embolism, thrombosis of the foramen channel or the atrial structures with subsequent embolism, transient arrhythmias, prothrombotic states and vasoactive substances passage have been proposed as physiopathologic mechanisms involved. Contrast-enhanced transesophageal echocardiography is the standard reference diagnostic procedure but contrast-enhanced transcranial Doppler is a good non-invasive alternative diagnostic tool that is highly sensitive and specific.
Subject(s)
Heart Septal Defects, Atrial , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/diagnostic imaging , Humans , UltrasonographyABSTRACT
No disponible
Subject(s)
Humans , Brain Death , Brain Ischemia , Cerebrovascular Circulation , Critical Illness , Telencephalon/physiopathologyABSTRACT
No disponible
