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Case Reports
. 2014 Apr-Jun;26(2):193-9.
doi: 10.5935/0103-507x.20140028.

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

[Article in English, Portuguese]
Rodrigo Cornejo  1 , Carlos Romero  1 , Diego Ugalde  1 , Patricio Bustos  2 , Gonzalo Diaz  1 , Ricardo Galvez  1 , Osvaldo Llanos  1 , Eduardo Tobar  1
Affiliations
Case Reports

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

[Article in English, Portuguese]
Rodrigo Cornejo et al. Rev Bras Ter Intensiva. 2014 Apr-Jun.

Abstract
in English, Portuguese

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.

Relatamos o tratamento bem-sucedido de dois pacientes com hemorragia subaracnóidea complicada com grave falência respiratória e choque séptico refratário, utilizando, simultaneamente, ventilação em posição prona e hemofiltração de alto volume. Esses tratamentos de resgate permitiram que os pacientes superassem a grave situação sem complicações associadas ou efeitos deletérios na pressão intracraniana e de perfusão cerebral. A ventilação em posição prona é, hoje, um tratamento aceito para síndrome de desconforto respiratório agudo grave, e a hemofiltração de alto volume é um suporte hemodinâmico não convencional, que tem diversos mecanismos potenciais para melhorar o choque séptico. Neste artigo revisamos brevemente esses tratamentos e as evidências relacionadas. Quando outras terapias convencionais são insuficientes para proporcionar oxigenação e perfusão como parte do cuidado neuroprotetor básico dentro de limites seguros em pacientes com hemorragia subaracnóidea, esses tratamentos de resgate podem ser considerados caso a caso por uma equipe com experiência em cuidados críticos.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Time course of oxygenation (PaO2:FiO2), vasopressor requirement (norepinephrine dose), and intracranial pressure during the rescue therapies in both patients (cases 1 and 2). The dotted line demarks the prone position ventilation period, and the gray area with interrupted line borders marks the high-volume hemofiltration period. PaO2:FiO2 - pressure arterial oxygen: fraction of inspired oxygen; ICP - intracranial pressure; PPV - prone position ventilation; HVHF - high-volume hemofiltration.
See this image and copyright information in PMC

Comment in

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