The effect of lung-protective permissive hypercapnia in intracerebral pressure in patients with subarachnoid haemorrhage and ARDS. A retrospective study

Abstract

Patients with higher Hunt and Hess grades of subarachnoid haemorrhage who are predominantly intubated and ventilated and most of them suffer from ARDS can receive lung protective ventilation. In our small patient collective, the occurring hypercapnia did not influence (increase) the intracerebral pressure.

Pros and cons of permissive hypercapnia in patients with subarachnoid haemorrhage and ARDS

“…As a conclusion, the treatment reported in the paper by Petridis and colleagues [6]-even if there are really interesting aspects, especially the potentially neuroprotective role of mild to moderate hypercapnia [8]-cannot generally be recommended until studies with a better design, especially controlled, randomized studies, have confirmed the results.…”

“…In my opinion, permissive hypercapnia should to date only be administered in patients with a therapy refractory ARDS in whom advanced methods to reduce hypercarbia-e.g., jet ventilation or interventional lung assist devices-if available-have not been successful, i.e., as a form of an individual treatment attempt. A continuously performed ICP monitoring seems to be mandatory-as performed by the authors in the paper [6].…”

“…Petridis and colleagues describe their results of intracranial pressure (ICP) analysis in 12 patients after subarachnoid haemorrhage (SAH) treated with permissive hypercapnia due to acute respiratory distress syndrome (ARDS) [6].…”

“…Furthermore, it has to be pointed out that there are some methodological weaknesses of the paper [6]: This is not a controlled randomized clinical study, but the report of a retrospective observation of non-consecutive patients. Another important point is that ICP measurements have been performed while the external ventricular drainage (EVD) was still open: Thus, it is unclear whether hypercapniainduced intracranial vasodilatation has not been compensated by an increase of CSF outflow via the EVD.…”

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

“…Several small studies suggest that lung protective ventilation strategies causing mild hypercarbia in patients with elevated ICP may be tolerated [63,64], but more data are needed before this may be considered safe in routine practice. Prone positioning seems to increase ICP [65], although several studies show that a small increase in ICP may be more than offset by dramatic improvements in oxygenation.…”