Desenlaces clínicos en pacientes con lesión cerebral aguda no traumática y variación del diámetro de la vaina del nervio óptico en una unidad de cuidado intensivo de Barranquilla desde diciembre del año 2023 hasta diciembre del 2024
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Fecha
2025
Autores
González González, Ivonne del Carmen
Forero Palacio, Víctor Alfonso
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Introducción: Las lesiones cerebrales agudas no traumáticas (LCA-NT)
constituyen una causa frecuente de ingreso a UCI. El monitoreo no invasivo del
estado neurológico mediante el diámetro de la vaina del nervio óptico (DVNO) se ha
propuesto como una herramienta útil para detectar hipertensión endocraneana.
Objetivo: Evaluar la asociación entre el DVNO y los desenlaces clínicos en
pacientes con LCA-NT en una UCI de cuarto nivel en Barranquilla.
Métodos: Estudio prospectivo, descriptivo y de cohorte longitudinal. Se incluyeron
pacientes adultos con diagnóstico confirmado de LCA-NT entre diciembre de 2023
y diciembre del 2024. Se realizaron mediciones seriadas del DVNO a las 24, 48 y
72 horas. Se evaluaron la mortalidad intrahospitalaria, la necesidad de ventilación
mecánica invasiva (VMI), la duración de estancia hospitalaria y estancia en UCI. Se
aplicaron pruebas univariadas y regresión logística multivariada.
Resultados: Se analizaron 82 pacientes. Un DVNO ≥ 5 mm a las 24 horas se asoció
significativamente con mayor mortalidad intrahospitalaria ((OR = 2.56; p = 0.008; IC
95%: 1.28–5.12), necesidad de VMI (OR = 2.30; p = 0.012; IC 95%: 1.20–4.40). La
estancia hospitalaria y en UCI fue significativamente más prolongada en los
pacientes que presentaron desenlace fatal.
Conclusiones: El DVNO es un biomarcador accesible, no invasivo y de utilidad
pronóstica en pacientes con LCA-NT. Su inclusión en los algoritmos clínicos permite
anticipar complicaciones graves, especialmente en contextos sin monitoreo invasivo
de la PIC.
Introduction: Non-traumatic acute brain injury (NT-ABI) is a frequent and complex condition in intensive care units. Non-invasive neurological monitoring using optic nerve sheath diameter (ONSD) has emerged as a promising surrogate for estimating intracranial pressure (ICP). Objective: To evaluate the association between ONSD and clinical outcomes in NT-ABI patients admitted to a fourth-level ICU in Barranquilla, Colombia. Methods: Prospective, descriptive, longitudinal study. Adult patients diagnosed with NT-ABI between December 2023 and December 2024 were included. Serial ONSD measurements were taken at 24, 48, and 72 hours. Outcomes included in-hospital mortality, need for invasive mechanical ventilation (IMV), hospital stay and ICU length of stay. Univariate analysis and multivariate logistic regression were applied. Results: A total of 82 patients were analyzed. An ONSD ≥ 5 mm at 24 hours was significantly associated with higher in-hospital mortality (adjusted OR: 2.56; p = 0.008; IC 95%: 1.28–5.12), increased need for IMV (adjusted OR: 2.30; p = 0.012; IC 95%: 1.20–4.40). Patients who died had significantly longer hospital and ICU stays. Conclusions: ONSD is a reliable, non-invasive prognostic biomarker in NT-ABI. Its integration into critical care protocols may improve early decision-making and reduce complications from unrecognized intracranial hypertension.
Introduction: Non-traumatic acute brain injury (NT-ABI) is a frequent and complex condition in intensive care units. Non-invasive neurological monitoring using optic nerve sheath diameter (ONSD) has emerged as a promising surrogate for estimating intracranial pressure (ICP). Objective: To evaluate the association between ONSD and clinical outcomes in NT-ABI patients admitted to a fourth-level ICU in Barranquilla, Colombia. Methods: Prospective, descriptive, longitudinal study. Adult patients diagnosed with NT-ABI between December 2023 and December 2024 were included. Serial ONSD measurements were taken at 24, 48, and 72 hours. Outcomes included in-hospital mortality, need for invasive mechanical ventilation (IMV), hospital stay and ICU length of stay. Univariate analysis and multivariate logistic regression were applied. Results: A total of 82 patients were analyzed. An ONSD ≥ 5 mm at 24 hours was significantly associated with higher in-hospital mortality (adjusted OR: 2.56; p = 0.008; IC 95%: 1.28–5.12), increased need for IMV (adjusted OR: 2.30; p = 0.012; IC 95%: 1.20–4.40). Patients who died had significantly longer hospital and ICU stays. Conclusions: ONSD is a reliable, non-invasive prognostic biomarker in NT-ABI. Its integration into critical care protocols may improve early decision-making and reduce complications from unrecognized intracranial hypertension.
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Palabras clave
Lesión cerebral aguda, Diámetro de la vaina del nervio óptico, Ultrasonografía, Presión intracraneana, Cuidados intensivos, Monitoreo no invasivo
