Abstract：
:A 20-year-old man was admitted in the neurology ICU 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. 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 (S(pO(2)) < 75%) occurred, which were not responsive to increasing PEEP and recruitment maneuvers. Hypoxemia was complicated by further increase in intracranial pressure. Ventilation in the prone position was not tolerated. The introduction of inhaled nitric oxide 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 the prone position can also be helpful in improving oxygenation, but is not always possible. The potential benefit of inhaled nitric oxide in similar cases has been described, but has still to be further explored.
journal_name
Respir Carejournal_title
Respiratory careauthors
Vanhoonacker M,Roeseler J,Hantson Pdoi
10.4187/respcare.01322subject
Has Abstractpub_date
2012-07-01 00:00:00pages
1186-90issue
7eissn
0020-1324issn
1943-3654pii
rc01322r2vanhoonackerjournal_volume
57pub_type
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