| Reciprocal Influence of Refractory Hypoxemia and High Intracranial Pressure on the Postoperative Management of an Urgent Neurosurgical Procedure. | |
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MedLine Citation:
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PMID: 22272580 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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A 20-year-old man was admitted in the neurointensive care unit after the drainage of a large frontal hematoma related to the spontaneous bleeding of a recently diagnosed cavernoma. On admission, the Glasgow Coma Score was 4/15, with evidence of sub-falcorial herniation and elevated intracranial pressure (ICP). On the 4th postoperative day, the patient developed acute lung injury with an apparently normal bedside chest-X-ray examination. Several episodes of critical oxygen desaturation (SpO₂ < 75%) occurred, which were not responsive to increasing positive end expiratory pressure (PEEP) and recruitment maneuvers. Hypoxemia was complicated by further increase in ICP. Ventilation in prone position was not tolerated. The introduction of inhaled nitric oxide (NO) allowed a rapid and sustained improvement of both arterial oxygenation and cerebral hemodynamics. Interactions between acute brain and lung injury are complex. The correction of hypoxemia can usually be achieved by increasing PEEP or by alveolar recruitment maneuvers. Ventilation in prone position can also be helpful to improve oxygenation but is not always possible. The potential benefit of inhaled NO in similar cases was already described but has still to be further explored. |
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Authors:
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Mieke Vanhoonacker; Jean Roeseler; Philippe Hantson |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-23 |
Journal Detail:
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Title: Respiratory care Volume: - ISSN: 0020-1324 ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-1-25 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7510357 Medline TA: Respir Care Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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