Department of Intensive Care Medicine, Cliniques St-Luc, Université Catholique de Louvain, Brussels, Belgium.
Respir Care. 2012 Jul;57(7):1186-90. doi: 10.4187/respcare.01322. Epub 2012 Jan 23.
A 20-year-old man was admitted in the neurology ICU after the drainage of a large frontal hematoma related to the spontaneous bleeding of a recently diagnosed cavernoma. On admission the Glasgow coma score was 4/15, with evidence of sub-falcorial herniation and elevated intracranial pressure. On the 4th postoperative day the patient developed acute lung injury, with an apparently normal bedside chest x-ray examination. Several episodes of critical oxygen desaturation (S(pO(2)) < 75%) occurred, which were not responsive to increasing PEEP and recruitment maneuvers. Hypoxemia was complicated by further increase in intracranial pressure. Ventilation in the prone position was not tolerated. The introduction of inhaled nitric oxide allowed a rapid and sustained improvement of both arterial oxygenation and cerebral hemodynamics. Interactions between acute brain and lung injury are complex. The correction of hypoxemia can usually be achieved by increasing PEEP or by alveolar recruitment maneuvers. Ventilation in the prone position can also be helpful in improving oxygenation, but is not always possible. The potential benefit of inhaled nitric oxide in similar cases has been described, but has still to be further explored.
一位 20 岁男性因近期诊断为海绵状血管瘤自发性出血导致的额部大血肿引流后被收入神经重症监护病房。入院时格拉斯哥昏迷评分（Glasgow coma score）为 4/15，有小脑幕切迹下疝和颅内压升高的证据。术后第 4 天，患者发生急性肺损伤，床边胸部 X 线检查似乎正常。发生了几次严重的氧饱和度下降（S(pO(2)) < 75%），增加呼气末正压（PEEP）和肺复张手法都没有反应。低氧血症进一步加重颅内压升高。俯卧位通气不能耐受。吸入一氧化氮的引入允许快速和持续地改善动脉氧合和脑血流动力学。急性脑和肺损伤之间的相互作用很复杂。通过增加 PEEP 或通过肺泡复张手法通常可以纠正低氧血症。俯卧位通气也有助于改善氧合，但并非总是可行。吸入一氧化氮在类似情况下的潜在益处已经被描述，但仍需要进一步探索。
