The effect of lung-protective permissive hypercapnia in intracerebral pressure in patients with subarachnoid haemorrhage and ARDS. A retrospective study.
OBJECTIVE
Lung protective ventilation has a beneficial effect in treating patients with acute respiratory distress syndrome (ARDS). An effect of this ventilation modality is hypercapnia, which leads to increased cerebral blood flow. Since increased cerebral blood flow can induce brain oedema the question arises whether lung protective ventilation can be applied in patients with subarachnoid haemorrhage.


METHODS
We retrospectively analysed 12 patients with subarachnoid haemorrhage who were ventilated with lung protective ventilation since they suffered of ARDS. Tidal volume was 5-8 ml/kg body weight, and positive end expiratory pressure was 10-15 cm H₂O. Intracerebral pressure was continuously measured by intracerebral probe.


RESULTS
Despite of hypercapnia (pCO₂ 50-60 mmHg) there was no increase of the intracerebral pressure. Lung protective ventilation could be safely performed in patients with subarachnoid haemorrhage.


CONCLUSIONS
Patients with higher Hunt and Hess grades of subarachnoid haemorrhage who are predominantly intubated and ventilated and most of them suffer from ARDS can receive lung protective ventilation. In our small patient collective, the occurring hypercapnia did not influence (increase) the intracerebral pressure.
Petridis
Athanasios K
AK
Neurosurgical Department, University Hospital Schleswig Holstein, Kiel, Germany. opticdisc@aol.com
Doukas
Alexandros
A
Kienke
Sven
S
Maslehaty
Homajoun
H
Mahvash
Mehran
M
Barth
Harald
H
Mehdorn
Hubertus Maximilian
HM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000503:physiopathology*; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology