| Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Der Anaesthesist | ||||
| Publisher: | SPRINGER-VERLAG | ||||
| Place of Publication: | NEW YORK | ||||
| Volume: | 51 | ||||
| Number of Issue or Book Chapter: | 7 | ||||
| Page Range: | pp. 552-556 | ||||
| Date: | 2002 | ||||
| Institutions: | Medicine > Lehrstuhl für Anästhesiologie Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie Medicine > Lehrstuhl für Neurochirurgie | ||||
| Identification Number: |
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| 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 | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 72866 |
Web of ScienceAbstract
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 ...
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.
Metadata last modified: 19 Dec 2024 15:42
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