Evaluación y manejo del dolor en el paciente neurocrítico no comunicativo

Juan José Valero

Autores/as

Juan José Valero Neurocirujano. Máster en Neurología y Dolor https://orcid.org/0009-0008-2907-0623

Palabras clave:

Dolor, Cuidados críticos, Unidades de cuidados intensivos, Medición del dolor, Personas con discapacidad para la comunicación, Analgesia, Sedación, Ventilación mecánica

Resumen

Introducción: El dolor afecta al 50-80% de los pacientes en unidades de cuidados intensivos (UCI), con frecuencias aún mayores en el subgrupo neurocrítico. La imposibilidad de autoreporte por sedación profunda, intubación, ventilación mecánica oalteración del estado de conciencia genera un infradiagnóstico sistémico con consecuencias deletéreas: agitación, delirium,hiperalgesia inducida por opioides, síndrome de estrés postraumático post-UCI, prolongación de estancia y aumento de mortalidad.Objetivo: sintetizar críticamente la evidencia 2018-2026 sobre evaluación y manejo del dolor en el paciente neurocrítico no comunicativo, integrando escalas conductuales validadas, biomarcadores objetivos de nocicepción y estrategias terapéuticas multimodales adaptadasal contexto latinoamericano. Métodos: revisión narrativa estructurada con búsqueda sistemática en PubMed/MEDLINE, CochraneLibrary, Scopus, EMBASE y Web of Science (2018-2026), incluyendo guías de práctica clínica (PADIS 2018 y su actualización 2025),revisiones sistemáticas, ensayos clínicos pivote y estudios de validación. Resultados: La Behavioral Pain Scale (BPS) y la Critical-Care Pain Observation Tool (CPOT) constituyen los instrumentos conductuales con mejores propiedades psicométricas (Kappa > 0,70),recomendados por las guías PADIS para pacientes incapaces de autoinformar. Los biomarcadores objetivos pupilometría automática,Analgesia Nociception Index (ANI), Nociception Level (NOL) index. Conclusiones: El paciente neurocrítico no comunicativo demandauna aproximación multimodal mecanismo-dirigida que combine escalas conductuales validadas, biomarcadores objetivos cuando esténdisponibles, farmacoterapia escalonada e intervenciones no farmacológicas. La adaptación a las realidades del contexto latinoamericano limitada disponibilidad de tecnología avanzada y opiofobia regional constituye un imperativo ético y un terreno fértil para la investigaciónclínica regional.

Citas

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