ARCHIVED


2.01.08ARCHIVADA MONITOREO DEL FLUJO SANGUÍNEO CEREBRAL REGIOL USANDO U SONDA TERMICA
SecciónMedicina Fecha Original: 01/24/2005
SubsecciónMedicina Fecha Revisión6 de mayo de 2016
“Esta política está protegida por derechos de autor bajo las leyes federales y/o las leyes de propiedad intelectual y las de regulaciones estatales. Ninguna parte de esta publicación puede ser reproducida, almacenada en un sistema de recuperación, transmitida en cualquier forma o por cualquier medio, sea electrónico, mecánico, fotocopia, grabación o cualquier otro, sin el permiso escrito del plan de salud.”

Definición


La evaluación de la perfusión cerebral es un componente importante en el manejo de paciente con trauma cerebral, cirugía neurológica ataque cerebral, de varias etiologías incluyendo la hemorragia subaracnoidea. El vasospasmo que disminuye la irrigación sanguínea y que lleva a la isquemia y deterioro neurológico es una de las causas de mortalidad y morbilidad después de la hemorragia subaracnoidea (SAH). Todos estos pacientes son tratados inicialmente con nifedipine, un bloqueador de los canales de calcio, para prevenir el vasospasmo, que normalmente ocurre entre 5-17 días, después de la sangría inicial. Se refieren evaluaciones constantes para detectar el vasospasmo. Si esto se detecta, se inicia una terapia “Triple H”, que consiste en inducir hipertensión, hipervolemia con agentes coloidales y hemodilución.
El doppler transcraneal es la técnica mas comúnmente usada para evaluar la perfusión cerebral. Esta técnica es dificultosa, prolongada, solo evalúa un pequeño grupo de vasos sanguíneos y si la ventana del hueso temporal es muy densa no se puede realizar.
Recientemente FDA aprobó un sistema (Q Flow 500 Perfusion Monitoring System), donde se introduce una sonda térmica por un agujero de trépano que se coloca intracerebral, en el área del cerebro que está afectada. Este dispositivo consiste de dos termistores colocados al final de la sonda. De esta manera se puede monitorear continuamente el flujo sanguíneo en base de la convección termal producida.
Es interesante que este concepto pueda usarse en otros tejidos del cuerpo tales como: Monitoreo de la capa muscular del esófago. Monitoreo de la microcirculación de la cirugía reconstructiva. El monitoreo del flujo sanguíneo durante cirugías por trauma a la cabeza.
Política
Monitoreo de la circulación cerebral usando electrodos termales no se considera para pago. No hay datos suficientes que permitan llegar a conclusiones sobre el efecto de esta tecnología en los resultados finales.
Empleados federales podrán ser considerados como una excepción si existe un mandato federal y se les evaluara de acuerdo a la necesidad médica.
Códigos
Codes Number Description
CPT No specific CPT code
ICD-9 Diagnosis 430 Subarachnoid hemorrhage
852.00 - 852.19 Subarachnoid hemorrhage following injury, without or with open intracranial wound; code range
ICD-10-CM(effective 10/1/15) S06.6X0A subrac hem w/o loss of consciousness, init Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter
S06.6X0A subrac hem w/o loss of consciousness, init Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter
S06.6X1A subrac hem w LOC of 30 minutes or less, init Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, initial encounter
S06.6X2A subrac hem w loss of consciousness of 31-59 min, init Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.6X3A subrac hem w LOC of 1-5 hrs 59 min, init Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.6X4A subrac hem w LOC of 6 hours to 24 hours, init Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.6X5A subrac hem w LOC >24 hr w ret consc lev, init Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.6X6A subrac hem w LOC >24 hr w/o ret consc w surv, init Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.6X7A subrac hem w LOC w death d/t brain inj bf consc, init Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.6X8A subrac hem w LOC w death d/t oth cause bf consc, init Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.6X9A subrac hem w LOC of unsp duration, init Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter
S06.6X0A subrac hem w/o loss of consciousness, init Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter
S06.6X9A subrac hem w LOC of unsp duration, init Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter
S06.6X0A subrac hem w/o loss of consciousness, init Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter
S01.90XA open wound of unspecified part of head, init encntr Unspecified open wound of unspecified part of head, initial encounter
S06.6X0A subrac hem w/o loss of consciousness, init Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter
S01.90XA open wound of unspecified part of head, init encntr Unspecified open wound of unspecified part of head, initial encounter
S06.6X1A subrac hem w LOC of 30 minutes or less, init Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, initial encounter
S06.6X2A subrac hem w loss of consciousness of 31-59 min, init Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S01.90XA open wound of unspecified part of head, init encntr Unspecified open wound of unspecified part of head, initial encounter
S06.6X3A subrac hem w LOC of 1-5 hrs 59 min, init Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.6X4A subrac hem w LOC of 6 hours to 24 hours, init Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
S01.90XA open wound of unspecified part of head, init encntr Unspecified open wound of unspecified part of head, initial encounter
S06.6X5A subrac hem w LOC >24 hr w ret consc lev, init Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S01.90XA open wound of unspecified part of head, init encntr Unspecified open wound of unspecified part of head, initial encounter
S06.6X6A subrac hem w LOC >24 hr w/o ret consc w surv, init Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.6X7A subrac hem w LOC w death d/t brain inj bf consc, init Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.6X8A subrac hem w LOC w death d/t oth cause bf consc, init Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S01.90XA open wound of unspecified part of head, init encntr Unspecified open wound of unspecified part of head, initial encounter
S06.6X9A subrac hem w LOC of unsp duration, init Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter
S01.90XA open wound of unspecified part of head, init encntr Unspecified open wound of unspecified part of head, initial encounter
S06.6X0A subrac hem w/o loss of consciousness, init Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter
S06.6X9A subrac hem w LOC of unsp duration, init Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter

Limitación
Según lo establecido en póliza.
___________ ____________________________________
Ángela Hernández, MD Enid Mateo Reyes, MD
Director Médico Asociado Director Médico Asociado
Rev. 05/06/2016
01/23/12 (ICD-10 added)
01/26/09 (iCES)
03/15/07
01/24/05

Referencias

  • Vajkoczy P, Roth H, Horn P et al. Continuous monitoring of regional cerebral blood flow; experimental and clinical validation of a novel thermal diffusion microprobe. J Neurosurg 2000; 93(2):265-74.

  • Thome C, Vajkoczy P, Horn P et al. Continuous monitoring of regional cerebral blood flow during temporary arterial occlusion in aneurysm surgery. J Neurosurg 2001; 95(3):402-11.

  • Vajkoczy P, Horn P, Thome C et al. Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg 2003; 98(6):1227-34.

  • Jaeger M, Soehle M, Schuhmann MU et al. Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir (Wien) 2005; 147(1):51-6.

  • Barth M, Capelle H-H, Münch E et al. Effects of the selective endothelin A (ET A ) receptor antagonist clazosentan on cerebral perfusion and cerebral oxygenation following severe subarachnoid hemorrhage – preliminary results from a randomized clinical series. Acta Neurochir (Wien) 2007; 149 (9):911-8.