title: 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.
authors.affiliation: Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cornejo
authors.affiliation: Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Romero
authors.affiliation: Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Diego
authors.initials: D
authors.lastname: Ugalde
authors.affiliation: Departamento de Neurologia e Neurocirurgia, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Patricio
authors.initials: P
authors.lastname: Bustos
authors.affiliation: Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Diaz
authors.affiliation: Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Galvez
authors.affiliation: Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Llanos
authors.affiliation: Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tobar
mesh_terms: D000328:Adult; D005260:Female; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D008297:Male; D016684:Prone Position; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000209:etiology / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome