Intracranial Hypertension and Adult Respiratory Distress Syndrome

Abstract

The management of increased intracranial pressure (ICP) in patients with an associated acute lung injury is difficult. High levels of Pacosub 2 as tolerated for permissive hypercapnia are deleterious for cerebral circulation. In such circumstances, tracheal gas insufflation (TGI), which was recently proposed to reduce Pacosub 2 , may be of benefit. We report the cases of two patients with severe adult respiratory distress syndrome and head trauma complicated with elevated ICP. The introduction of TGI decreased Pacosub 2 by 17 and 26%, decreased ICP, and increased calculated cerebral perfusion pressure. We conclude that TGI could be added to a pressure-targeted strategy of ventilatory management when severe adult respiratory distress syndrome was associated to an intracranial hypertension.