Bein, Thomas and Kuhr, LP and Metz, C and Woertgen, C and Philipp, A and Taeger, K (2002) Acute respiratory distress syndrome and severe brain injury. ANAESTHESIST, 51 (7). pp. 552-556. ISSN 0003-2417
Full text not available from this repository. (Request a copy)Abstract
The development of adult respiratory distress syndrome (ARDS) complicates the treatment of patients with severe head injury, since special therapeutic strategies for both conditions might lead to a "conflict of interests." We report on the intensive care treatment of a young man who suffered severe brain injury (Glasgow Coma Scale =3) due to a traffic accident and simultaneously developed ARDS from the aspiration of gastric content. We performed extensive monitoring of cerebral hemodynamics and metabolism (intracranial pressure measurement,jugular bulb oxymetry, estimation of arterial-jugular bulb lactate concentration difference) to prevent cerebral hypoxia and to control cerebral hyperemia. The application of a "lung protective strategy" with "permissive hypercapnia" led to a conflict, since the development of cranial hyperemia combined with cranial hypertension a few days after trauma, warranted the concept of controlled, temporary hyperventilation. Therefore, we applied a pumpless extracorporeal lung assist to improve carbon dioxide elimination. Furthermore, we started the ventilation in the prone position, since arterial oxygenation continued to deteriorate, although there is a lack of data describing the effect of a prone position on acute cerebral injury. Positioning the patient prone, we observed a prompt increase in intracranial pressure, which resulted in pharmacological intervention (mannitol). Treating the patient by intermittent prone position, by continuous extracorporeal lung assist and aerosolized prostacyclin administration in the following period, lung function improved and ARDS was treated successfully. After withdrawing the analgo-sedation the patient's vigilance rose continuously. The patient was transferred to a rehabilitation ward 33 days after admission to the intensive care unit. The combination of ARDS and severe brain injury needs special treatment, which includes extensive monitoring techniques to find a solution for therapeutic conflicts.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CEREBRAL PERFUSION-PRESSURE; SEVERE HEAD-INJURY; LUNG INJURY; PROSTACYCLIN; VENTILATION; HYPERCAPNIA; MORTALITY; THERAPY; EDEMA; brain injury; acute respiratory distress syndrome; jugular bulb oxymetry; lung protective ventilation; intracranial pressure |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie Medicine > Lehrstuhl für Neurochirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 13 Oct 2021 09:07 |
| Last Modified: | 13 Oct 2021 09:07 |
| URI: | https://pred.uni-regensburg.de/id/eprint/40093 |
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