Artikel
Optimizing decarboxylation in patients with concomitant severe brain injury and acute respiratory distress syndrome – Application of a pumpless extracorporeal lung assist device in critically ill neurosurgical patients
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Autoren
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Chistopher Munoz
- Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Düsseldorf, Deutschland
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Rainer Kram
- Klinik für Anästhesie und Intensivmedizin, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Düsseldorf, Deutschland
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Daniel Hänggi
- Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Düsseldorf, Deutschland
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Kerim Beseoglu
- Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Düsseldorf, Deutschland
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: The acute respiratory distress syndrome (ARDS) with concomitant impairment of oxygenation and decarboxylation in a neurosurgical intensive care unit (NICU) represents a complex problem in the management of intracranial pressure (ICP). To enable a sufficient oxygenation and lung protective ventilation, patients with elevated ICP cannot be treated with permissive hypercapnia. Pumpless extracorporeal lung assist devices (PECLA; iLA Membrane Ventilator®, Novalung, Heidelberg, Germany) can improve decarboxylation, thus avoiding the need for more invasive ventilation and at the same time stabilizing pCO2 at tolerable levels for patients requiring rigorous ICP management. In a small pilot series, we analyzed feasibility and effect of PECLA in patients with ARDS and elevated ICP after brain injury (BI).
Method: The medical records of five patients (4 male, 1 female) with ARDS and severe BI concurrently managed with an external ventricular drainage in the NICU were analyzed in retrospect. As a surrogate for the effect of PECLA on ventilation, the difference between maximal inspiratory pressure and positive endexspiratory pressure (Delta P) in the days preceding the implantation of PECLA was compared to the days after. To evaluate the effect on ICP management volume of daily cerebrospinal fluid (CSF) drainage to maintain the set ICP threshold of 20mmHg was compared before and after Implantation. The mean was 16.5±3.1 mmHg to 13.0±0.8 mmHg. However, this change was marginally not significant (p=0.059). The volume of daily CSF drainage to maintain a controlled ICP decreased significantly from 97.8±73.9 ml to 32.5±32.8 ml (p=0.043).
Conclusions: For selected patients with concomitant severe TBI and lung injury, the application of PECLA is feasible and safe to control decarboxylation, thus enabling optimal ventilation parameters while avoiding hypercapnia which is potentially harmful for ICP. Larger prospective trials are warranted and necessary to further elucidate the application of lung assist devices in NICU patients.
