2. MODULO: TRAUMA DE CRANEO
MANEJO NEUROINTENSIVO DE
LA HIPERTENSION
ENDOCRANEAL
Dr. Simón Patricio Gutiérrez
Medico Intensivista. Unidad de Terapia Intensiva de Adultos/Obstetricia. Hospital de
Especialidades Materno Infantil. Caja Nacional de Salud. La Paz, Bolivia.
Presidente de la Sociedad Boliviana de Medicina Critica y Terapia Intensiva filial La Paz.
3. Wykes V, Vindlacheruvu R. Intracranial pressure, cerebral blood flow and brain oedema. Surg
Infect (Larchmt). 2015;33(8):355–62.
4. Bernard F. Neurotrauma and Intracranial Pressure Management. Crit Care Clin 39 (2023) 103–
121
https://doi.org/10.1016/j.ccc.2022.08.002
5. Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin R, Ghajar J, Harris O, Hoffer A,
Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo D, Patel M, Robertson C, Rosenfeld
JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein D, Stocchetti N, Taccone FS, Timmons S, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW,
Zammit C, Chesnut RM. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury
Consensus Conference (SIBICC). Intensive Care Med. 2019 Dec;45(12):1783-1794. doi: 10.1007/s00134-019-05805-9. Epub 2019 Oct 28. PMID:
31659383; PMCID: PMC6863785.
10. Que no hacer al ascenso de la PIC?
Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin R, Ghajar J, Harris O, Hoffer A,
Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo D, Patel M, Robertson C, Rosenfeld
JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein D, Stocchetti N, Taccone FS, Timmons S, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW,
Zammit C, Chesnut RM. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury
Consensus Conference (SIBICC). Intensive Care Med. 2019 Dec;45(12):1783-1794. doi: 10.1007/s00134-019-05805-9. Epub 2019 Oct 28. PMID:
31659383; PMCID: PMC6863785.
12. Causas de hipertensión endocraneana
Intracraneal
• Extrinsic compression
• Depressed skull fractures
• Subdural, extradural
hematomas
• Cerebral contusions
• Cerebral edema
• Thrombosis
• CNS infection
• Seizures
Extracraneal
• Hypotension
• Hypoxia
• Hypercapnia
• Electrolyte disorders
• Hypoglycemia
• Hyperthermia
• Coagulopathy Infections
• Cervical collars
• Neck lateralization
• Jugular thrombosis (central line, SVjO2 monitoring devices)
• Orotracheal tube tethering
• Pneumothorax
• Hemothorax
• Inadequate PEEP levels
• Airway obstruction
• Thrombosis (central line)
• Severe pulmonary embolism
• Asynchrony with mechanical ventilator
• Fluid Resuscitation
• Ileus
• Gastroparesis
• Pneumoperitoneum Hemoperitoneum
• Gourgiotis S, Villias C, Germanos S, Foukas A, Ridolfini MP. Acute
limb compartment syndrome: a review. J Surg Educ.
2007;64(3):178–86.
• Pereira BM. Abdominal compartment syndrome and intra-
abdominal hypertension. Curr Opin Crit Care. 2019;25(6):688–96.
• Pereira R, Buglevski M, Perdigoto R, Marcelino P, Saliba F, Blot S,
Starkopf J. Intra-abdominal hypertension and abdominal
compartment syndrome in the critically ill liver cirrhotic patient-
prevalence and clini- cal outcomes. A multicentric retrospective
cohort study in intensive care. PLoS ONE. 2021;16(5):e0251498.
13. Godoy et al. The intracranial compartmental syndrome: a proposed model for acute brain injury
monitoring and management. Critical Care (2023) 27:137 https://doi.org/10.1186/s13054-023-04427-4
14. Schizodimos T et al. An overview of management of intracranial hypertension in the
intensive care unit Journal of Anesthesia (2020) 34:741–757.
https://doi.org/10.1007/s00540-020-02795-7
15. Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin R, Ghajar J, Harris O, Hoffer A,
Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo D, Patel M, Robertson C, Rosenfeld
JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein D, Stocchetti N, Taccone FS, Timmons S, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW,
Zammit C, Chesnut RM. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury
Consensus Conference (SIBICC). Intensive Care Med. 2019 Dec;45(12):1783-1794. doi: 10.1007/s00134-019-05805-9. Epub 2019 Oct 28. PMID:
31659383; PMCID: PMC6863785.
16. Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin R, Ghajar J, Harris O, Hoffer A,
Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo D, Patel M, Robertson C, Rosenfeld
JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein D, Stocchetti N, Taccone FS, Timmons S, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW,
Zammit C, Chesnut RM. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury
Consensus Conference (SIBICC). Intensive Care Med. 2019 Dec;45(12):1783-1794. doi: 10.1007/s00134-019-05805-9. Epub 2019 Oct 28. PMID:
31659383; PMCID: PMC6863785.
17. Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin R, Ghajar J, Harris O, Hoffer A,
Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo D, Patel M, Robertson C, Rosenfeld
JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein D, Stocchetti N, Taccone FS, Timmons S, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW,
Zammit C, Chesnut RM. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury
Consensus Conference (SIBICC). Intensive Care Med. 2019 Dec;45(12):1783-1794. doi: 10.1007/s00134-019-05805-9. Epub 2019 Oct 28. PMID:
31659383; PMCID: PMC6863785.
36. Implementación de coma barbitúrico en TCE grave
Pérez-Bárcena J, Llompart-Pou JA, Homar J, et al. Pentobarbital versus thiopental in the treatment of
refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled
trial. Crit Care. 2008;12(4): R112. PMID: 18759980.
37. Lee K, Mayer SA. Management of increased intracranial pres- sure. In: Kiwon L, editor. The NeuroICU
Book. 1st ed. New York, NY: McGraw-Hill; 2012. p. 213–225.
38. Schizodimos T et al. An overview of management of intracranial hypertension in the intensive care unit
Journal of Anesthesia (2020) 34:741–757. https://doi.org/10.1007/s00540-020-02795-7
46. Mensajes para llevar a casa
• Los umbrales recomendados de PIC (tratamiento si PIC > 22 mmHg) y CPP (entre 60 y 70
mmHg) se han revisado a partir de directrices anteriores.
• Los pacientes con PAS < 110 mmHg deben considerarse hipotensos, a diferencia de las guías
previas.
• La hipotermia profiláctica no se ha establecido como una estrategia neuro protectora primaria,
según datos adicionales recientes.
• No hay pruebas suficientes sobre los efectos en los resultados clínicos para respaldar el uso de
cualquier agente hiperosmolar específico.
• Aunque la hipotermia terapéutica reduce la PIC, no parece mejorar el resultado a largo plazo.
• Salvo la HIC espontánea, surgen datos recientes alentadores sobre el efecto positivo de la
cirugía precoz sobre la mortalidad en pacientes con HIC traumática.
• En el ensayo RESCUEicp, la Craniectomía Descompresiva para Hipertensión Intracraneana
refractarias a la terapia convencional redujeron la mortalidad pero no mejoraron los resultados
funcionales en pacientes con TCE.
• Carney N, Totten AM, OʼReilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition.
Neurosurgery. 2017; 80(1):6–15.
• Brain Trauma Foundation; American Association of Neurologi- cal Surgeons; Congress of Neurological Surgeons; Joint Sec- tion on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW,
Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma. 2007; 24 Suppl 1:S59–64.
• Cooper DJ, Nichol AD, Bailey M, Bernard S, Cameron PA, Pili-Floury S, Forbes A, Gantner D, Higgins AM, Huet O, Kasza J, Murray L, Newby L, Presneill JJ, Rashford S, Rosen- feld JV, Stephenson M, Vallance S, Varma D, Webb SAR, Trapani T, McArthur C; POLAR Trial Investigators and the
ANZICS Clinical Trials Group. Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial. JAMA. 2018; 320(21):2211–20.
• Andrews PJ, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JK, Murray GD; Eurotherm3235 Trial Collaborators. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med. 2015; 373(25):2403–12.
• Flynn LM, Rhodes J, Andrews PJ. Therapeutic hypothermia reduces intracranial pressure and partial brain oxygen tension in patients with severe traumatic brain injury: preliminary data from the Eurotherm3235 trial. Ther Hypothermia Temp Manag. 2015;5(3):143–51.
• Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM; STICH II Investigators. Early surgery versus ini- tial conservative treatment in patients with spontaneous supraten- torial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013; 382(9890):397–408.
• Mendelow AD, Gregson BA, Rowan EN, Francis R, McColl E, McNamee P, Chambers IR, Unterberg A, Boyers D, Mitchell PM; STITCH(Trauma) Investigators. Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First
Randomized Trial. J Neurotrauma. 2015; 32(17):1312–23.
• Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wad- ley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ;
RESCUEicp Trial Collaborators. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016; 375(12):1119–30.
47. Chesnut RM, Temkin N, Videtta W, Petroni G, Lujan S, Pridgeon J, Dikmen
S, Chaddock K, Barber J, Machamer J, Guadagnoli N, Hendrickson P,
Aguilera S, Alanis V, Bello Quezada ME, Bautista Coronel E, Bustamante
LA, Cacciatori AC, Carricondo CJ, Carvajal F, Davila R, Dominguez M,
Figueroa Melgarejo JA, Fillipi MM, Godoy DA, Gomez DC, Lacerda
Gallardo AJ, Guerra Garcia JA, Zerain GF, Lavadenz Cuientas LA, Lequipe
C, Grajales Yuca GV, Jibaja Vega M, Kessler ME, López Delgado HJ,
Sandi Lora F, Mazzola AM, Maldonado RM, Mezquia de Pedro N, Martínez
Zubieta JR, Mijangos Méndez JC, Mora J, Ochoa Parra JM, Pahnke PB,
Paranhos J, Piñero GR, Rivadeneira Pilacuán FA, Mendez Rivera MN,
Romero Figueroa RL, Rubiano AM, Saraguro Orozco AM, Silesky Jiménez
JI, Silva Naranjo L, Soler Morejon C, Urbina Z. Consensus-Based
Management Protocol (CREVICE Protocol) for the Treatment of Severe
Traumatic Brain Injury Based on Imaging and Clinical Examination for Use
When Intracranial Pressure Monitoring Is Not Employed. J Neurotrauma.
2020 Jun 1;37(11):1291-1299. doi: 10.1089/neu.2017.5599. Epub 2020
Mar 4. PMID: 32013721; PMCID: PMC7249475.
48. Chesnut RM, Temkin N, Videtta W, Petroni G, Lujan S, Pridgeon J, Dikmen S, Chaddock K, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Aguilera S, Alanis V, Bello Quezada ME, Bautista Coronel E, Bustamante LA,
Cacciatori AC, Carricondo CJ, Carvajal F, Davila R, Dominguez M, Figueroa Melgarejo JA, Fillipi MM, Godoy DA, Gomez DC, Lacerda Gallardo AJ, Guerra Garcia JA, Zerain GF, Lavadenz Cuientas LA, Lequipe C, Grajales
Yuca GV, Jibaja Vega M, Kessler ME, López Delgado HJ, Sandi Lora F, Mazzola AM, Maldonado RM, Mezquia de Pedro N, Martínez Zubieta JR, Mijangos Méndez JC, Mora J, Ochoa Parra JM, Pahnke PB, Paranhos J, Piñero
GR, Rivadeneira Pilacuán FA, Mendez Rivera MN, Romero Figueroa RL, Rubiano AM, Saraguro Orozco AM, Silesky Jiménez JI, Silva Naranjo L, Soler Morejon C, Urbina Z. Consensus-Based Management Protocol (CREVICE
Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed. J Neurotrauma. 2020 Jun 1;37(11):1291-1299. doi:
10.1089/neu.2017.5599. Epub 2020 Mar 4. PMID: 32013721; PMCID: PMC7249475.
49. Chesnut RM, Temkin N, Videtta W, Petroni G, Lujan S, Pridgeon J, Dikmen S, Chaddock K, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Aguilera S, Alanis V, Bello Quezada ME, Bautista Coronel E, Bustamante LA,
Cacciatori AC, Carricondo CJ, Carvajal F, Davila R, Dominguez M, Figueroa Melgarejo JA, Fillipi MM, Godoy DA, Gomez DC, Lacerda Gallardo AJ, Guerra Garcia JA, Zerain GF, Lavadenz Cuientas LA, Lequipe C, Grajales
Yuca GV, Jibaja Vega M, Kessler ME, López Delgado HJ, Sandi Lora F, Mazzola AM, Maldonado RM, Mezquia de Pedro N, Martínez Zubieta JR, Mijangos Méndez JC, Mora J, Ochoa Parra JM, Pahnke PB, Paranhos J, Piñero
GR, Rivadeneira Pilacuán FA, Mendez Rivera MN, Romero Figueroa RL, Rubiano AM, Saraguro Orozco AM, Silesky Jiménez JI, Silva Naranjo L, Soler Morejon C, Urbina Z. Consensus-Based Management Protocol (CREVICE
Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed. J Neurotrauma. 2020 Jun 1;37(11):1291-1299. doi:
10.1089/neu.2017.5599. Epub 2020 Mar 4. PMID: 32013721; PMCID: PMC7249475.
50. Chesnut RM, Temkin N, Videtta W, Petroni G, Lujan S, Pridgeon J, Dikmen S, Chaddock K, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Aguilera S, Alanis V, Bello Quezada ME, Bautista Coronel E, Bustamante LA,
Cacciatori AC, Carricondo CJ, Carvajal F, Davila R, Dominguez M, Figueroa Melgarejo JA, Fillipi MM, Godoy DA, Gomez DC, Lacerda Gallardo AJ, Guerra Garcia JA, Zerain GF, Lavadenz Cuientas LA, Lequipe C, Grajales
Yuca GV, Jibaja Vega M, Kessler ME, López Delgado HJ, Sandi Lora F, Mazzola AM, Maldonado RM, Mezquia de Pedro N, Martínez Zubieta JR, Mijangos Méndez JC, Mora J, Ochoa Parra JM, Pahnke PB, Paranhos J, Piñero
GR, Rivadeneira Pilacuán FA, Mendez Rivera MN, Romero Figueroa RL, Rubiano AM, Saraguro Orozco AM, Silesky Jiménez JI, Silva Naranjo L, Soler Morejon C, Urbina Z. Consensus-Based Management Protocol (CREVICE
Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed. J Neurotrauma. 2020 Jun 1;37(11):1291-1299. doi:
10.1089/neu.2017.5599. Epub 2020 Mar 4. PMID: 32013721; PMCID: PMC7249475.
51. Chesnut RM, Temkin N, Videtta W, Petroni G, Lujan S, Pridgeon J, Dikmen S, Chaddock K, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Aguilera S, Alanis V, Bello Quezada ME, Bautista Coronel E, Bustamante LA,
Cacciatori AC, Carricondo CJ, Carvajal F, Davila R, Dominguez M, Figueroa Melgarejo JA, Fillipi MM, Godoy DA, Gomez DC, Lacerda Gallardo AJ, Guerra Garcia JA, Zerain GF, Lavadenz Cuientas LA, Lequipe C, Grajales
Yuca GV, Jibaja Vega M, Kessler ME, López Delgado HJ, Sandi Lora F, Mazzola AM, Maldonado RM, Mezquia de Pedro N, Martínez Zubieta JR, Mijangos Méndez JC, Mora J, Ochoa Parra JM, Pahnke PB, Paranhos J, Piñero
GR, Rivadeneira Pilacuán FA, Mendez Rivera MN, Romero Figueroa RL, Rubiano AM, Saraguro Orozco AM, Silesky Jiménez JI, Silva Naranjo L, Soler Morejon C, Urbina Z. Consensus-Based Management Protocol (CREVICE
Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed. J Neurotrauma. 2020 Jun 1;37(11):1291-1299. doi:
10.1089/neu.2017.5599. Epub 2020 Mar 4. PMID: 32013721; PMCID: PMC7249475.
52. Chesnut RM, Temkin N, Videtta W, Petroni G, Lujan S, Pridgeon J, Dikmen S, Chaddock K, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Aguilera S, Alanis V, Bello Quezada ME, Bautista Coronel E, Bustamante LA,
Cacciatori AC, Carricondo CJ, Carvajal F, Davila R, Dominguez M, Figueroa Melgarejo JA, Fillipi MM, Godoy DA, Gomez DC, Lacerda Gallardo AJ, Guerra Garcia JA, Zerain GF, Lavadenz Cuientas LA, Lequipe C, Grajales
Yuca GV, Jibaja Vega M, Kessler ME, López Delgado HJ, Sandi Lora F, Mazzola AM, Maldonado RM, Mezquia de Pedro N, Martínez Zubieta JR, Mijangos Méndez JC, Mora J, Ochoa Parra JM, Pahnke PB, Paranhos J, Piñero
GR, Rivadeneira Pilacuán FA, Mendez Rivera MN, Romero Figueroa RL, Rubiano AM, Saraguro Orozco AM, Silesky Jiménez JI, Silva Naranjo L, Soler Morejon C, Urbina Z. Consensus-Based Management Protocol (CREVICE
Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed. J Neurotrauma. 2020 Jun 1;37(11):1291-1299. doi:
10.1089/neu.2017.5599. Epub 2020 Mar 4. PMID: 32013721; PMCID: PMC7249475.
53. Chesnut RM, Temkin N, Videtta W, Petroni G, Lujan S, Pridgeon J, Dikmen S, Chaddock K, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Aguilera S, Alanis V, Bello Quezada ME, Bautista Coronel E, Bustamante LA,
Cacciatori AC, Carricondo CJ, Carvajal F, Davila R, Dominguez M, Figueroa Melgarejo JA, Fillipi MM, Godoy DA, Gomez DC, Lacerda Gallardo AJ, Guerra Garcia JA, Zerain GF, Lavadenz Cuientas LA, Lequipe C, Grajales
Yuca GV, Jibaja Vega M, Kessler ME, López Delgado HJ, Sandi Lora F, Mazzola AM, Maldonado RM, Mezquia de Pedro N, Martínez Zubieta JR, Mijangos Méndez JC, Mora J, Ochoa Parra JM, Pahnke PB, Paranhos J, Piñero
GR, Rivadeneira Pilacuán FA, Mendez Rivera MN, Romero Figueroa RL, Rubiano AM, Saraguro Orozco AM, Silesky Jiménez JI, Silva Naranjo L, Soler Morejon C, Urbina Z. Consensus-Based Management Protocol (CREVICE
Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed. J Neurotrauma. 2020 Jun 1;37(11):1291-1299. doi:
10.1089/neu.2017.5599. Epub 2020 Mar 4. PMID: 32013721; PMCID: PMC7249475.
54. Chesnut RM, Temkin N, Videtta W, Petroni G, Lujan S, Pridgeon J, Dikmen S, Chaddock K, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Aguilera S, Alanis V, Bello Quezada ME, Bautista Coronel E, Bustamante LA,
Cacciatori AC, Carricondo CJ, Carvajal F, Davila R, Dominguez M, Figueroa Melgarejo JA, Fillipi MM, Godoy DA, Gomez DC, Lacerda Gallardo AJ, Guerra Garcia JA, Zerain GF, Lavadenz Cuientas LA, Lequipe C, Grajales
Yuca GV, Jibaja Vega M, Kessler ME, López Delgado HJ, Sandi Lora F, Mazzola AM, Maldonado RM, Mezquia de Pedro N, Martínez Zubieta JR, Mijangos Méndez JC, Mora J, Ochoa Parra JM, Pahnke PB, Paranhos J, Piñero
GR, Rivadeneira Pilacuán FA, Mendez Rivera MN, Romero Figueroa RL, Rubiano AM, Saraguro Orozco AM, Silesky Jiménez JI, Silva Naranjo L, Soler Morejon C, Urbina Z. Consensus-Based Management Protocol (CREVICE
Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed. J Neurotrauma. 2020 Jun 1;37(11):1291-1299. doi:
10.1089/neu.2017.5599. Epub 2020 Mar 4. PMID: 32013721; PMCID: PMC7249475.
