Prone Position Ventilation in a Patient of Severe ARDS with Raised Intracranial Pressure

Keywords

acute respiratory distress syndrome - neurotrauma - prone position ventilation - intracranial pressure

Introduction: Acute respiratory distress syndrome (ARDS) is common clinical problem in intensive care patients. It is characterized by high mortality. The mainstay of treatment is lung protective ventilation. Current evidence supports prone position ventilation in patients with ARDS having P/F ratio < 150. The only absolute contraindications stated for prone position ventilation are unstable vertebral fracture and unmonitored or significantly raised intracranial pressure.

Methodology/Description: A 27-year-old male was admitted after a road traffic accident with a left frontotem-poroparietal subdural hemorrhage with diffuse cerebral edema and bilateral diffuse pulmonary contusion. He was intubated in view of poor neurological status. He underwent decompressive craniectomy for raised intracranial pressure (ICP). In due course, he was tracheostomized. Later on, he developed bilateral chest infiltrates with hypoxia. He was diagnosed as severe ARDS (PF ratio < 100). He was decided for prone position ventilation. He was ventilated for 20 hours in prone position and 4 hours supine position in a day. After turning supine, ABG was done after 4 hours. Next session of proning was determined if PF ratio still < 150. He was given prone ventilation sessions daily for 5 days. After fifth proning, his oxygenation improved and further he did not require prone ventilation. Subsequently, he was decannulated and discharged without any neurological sequelae.

Conclusion: Proning can be safely considered in neurotrauma patients with severe ARDS on case to case basis.

• References

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