High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock

Abstract

We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team.

Efficacy Evaluation of High-Volume Hemofiltration in Patients with Severe Acute Respiratory Distress Syndrome

“…Hemofiltration has been proposed as a possible therapeutic option to improve oxygenation by promoting fluid removal, but its efficacy remains controversial. Several studies have concluded that continuous renal replacement therapy (CRRT), indicated for acute fluid overload (FO) and acute renal failure, improves oxygenation in patients with respiratory failure, hypoxia, and fulminant hepatitis [12][13][14][15][16][17][18]. However, others found no improvement in oxygenation.…”

Management of intracranial hypertension in patients neurocriticos: integrative review

“…The causes of HIC postoperative can present as a mass lesion (hematoma); Edema; Increased cerebral blood volume (vasodilation); LCR disorders. 5,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The most commonly used technique in clinical practice to monitor the peak involves an intraventricular or intraparenchymal catheter system, which is still considered the gold standard for monitoring ICP. These advances in PIC monitoring technique provides a variety of methods to assess ICP.…”

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“…In summary the possible effects adeversos stand out as isquemia cerebral, 6,13 hypoxia/hypoxemia cerebral, [14][15][16][17][18][19][20][21][22] febre, 6,15 cerebral, [13][14][15][23][24][25] herniation, interference bloodstream/delay intracraniano, 14 blood flow, decreased perfusão, 14 pressure obstruction venoso, 14 reflux renal, 15 failure, hiperglicemia, [26][27][28][29][30][31] hipoglicemia, 26 death/ encefálica, 15,19,22 death, infection due to insertion of the catheter for monitoring PIC, 17,20,29 line offset média, 17 Hematoma, 17,19,29 intracerebral hemorrhage, 17,18,[20][21][22][23]30,31 secundária brain injury, 18 edema ...…”

“…Trauma (epidural and subdural hematoma, brain contusion); nontraumatic intracerebral hemorrhage;BIRD; hydrocephalus;HICbenign or idiopathic; other (pseudotumor cerebri, pneumoencéflo, cysts and abscesses, brain). 6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The main secondary causes (extracranial) are airway obstruction; Hypoxia or hypercapnia or hypercarbia (hypoventilation); Hypertension (pain / cough) and hypotension (hypovolemia / sedation); Posture of the patient (head rotation); hyperpyrexia; seizures; And metabolic drugs (e.g., tetracycline, rofecoxib, divalproex sodium, lead poisoning); Others (eg, cerebral edema high altitude, liver failure). The causes of HIC postoperative can present as a mass lesion (hematoma); Edema; Increased cerebral blood volume (vasodilation); LCR disorders.…”