Farmacoterapia no traumatismo craniano. Onde estamos? Para onde vamos? Porém, quando vamos?

Resumo

O traumatismo cranioencefálico (TCE) apresenta aumento de sua prevalência e é um desafio para a sociedade atual. Lesões primárias são aquelas que ocorrem no momento do impacto. Lesões secundárias são as que ocorrem após a lesão inicial como uma resposta fisiológica/patológica. Isso causa uma cascata de eventos que pode durar um longo período. Enquanto as lesões primárias são irreverssíveis, as secundárias são potencialmente evitáveis se forem submetidas a triagem e estabilização adequadas, assim como ao correto manejo da oxigenação cerebral e controle da hipertensão intracraniana e pressão de perfusão cerebral. Devemos considerar o traumatismo craniano como um evento dinâmico com inúmeras janelas terapêuticas possíveis. Nesse contexto o desenvolvimento de agentes farmacológicos no tratamento do TCE é urgente. Na presente revisão os autores descrevem os principais fármacos que estão sendo estudados nos pacientes com traumatismo craniano. Concluímos que, apesar de investimentos substanciais em estudos de fase I e II, ainda há muitas lacunas no conhecimento, portanto esforços são necessários para que haja uma translação mais rápida para estudos de fase III.

Abstract

Traumatic brain injury (TBI) is an increasingly prevalent and complex challenge for society. Primary injuries are defined as those that occur at the moment of impact. Secondary injuries are those that occur after the initial injury as a consequence of physiologic / pathologic response to injury. This triggers a cascade of pathophysiological events that can extend over a long period of time. Whereas the primary injuries are considered irreversible, secondary injuries are potentially preventable with efficient triage and stabilization, management of parameters such as brain oxygenation, intracranial pressure, and cerebral perfusion pressure. Indeed, TBI should be thought of not as a static event, but rather a progressive injury with varying therapeutic windows. In this context the development of pharmacological treatment of patients with traumatic brain injury is urgent. In this review the authors describe the main drugs that are being studied in TBI patients. We conclude, despite substantial and ongoing investments in both phase I and II studies, there remain significant gaps in knowledge and faster translation to phase III clinical studies is mandatory.

Palavras-Chave

Traumatismo Craniano - Reabilitação - Farmacoterapia

Keywords

Traumatic Brain Injury - Rehabilitation - Pharmacotherapy

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