Status Asthmaticus and Central Herniation: A Case for Multidisciplinary Critical Care.
A 24-year-old woman with history of asthma was intubated emergently for acute status asthmaticus triggered by acute respiratory syncytial virus infection and treated with permissive hypercapnia. Her ventilation was complicated by auto-positive end-expiratory pressure and elevated peak airway, plateau, and central venous pressures. On hospital day 2, she was noted to have anisocoria. Imaging showed diffuse cerebral edema with central herniation. Difficult ventilation and hypercapnia directly contributed to her severe cerebral edema. Comanagement between neurologic and medical/pulmonary intensivists enabled the management of the competing treatment requirements for status asthmaticus and cerebral edema. This case highlights the importance of balancing conflicting physiologic needs and collaboration between teams.
From the Departments of *Anesthesiology and Perioperative Medicine, †Neurosurgery, and ‡Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, Oregon; and §Anesthesiology, Columbia University, New York, New York.
Joelle B
JB
Karlik
Tristan
T
Stani
Stephanie
S
Nonas
Aclan
A
Dogan
Ansgar
A
Brambrink
D000208:Acute Disease; D001929:Brain Edema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006547:Hernia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010348:Patient Care Team; D020127:Recovery of Function; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D012720:Severity of Illness Index; D013224:Status Asthmaticus / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult