This protocol covers patients with aneurysmal subarachnoid hemorrhage (aSAH) who develop severe acute respiratory distress syndrome (ARDS) with life-threatening hypoxemia — a critical dual-threat requiring simultaneous attention to cerebral and pulmonary status.
When severe ARDS complicates aSAH, management focuses on rescue maneuvers to restore adequate oxygenation, conducted under continuous intracranial pressure monitoring. The specific interventions used, and the conditions governing their application, are laid out in the full structured protocol.
The primary target is a meaningful increase in arterial oxygen partial pressure, achieved without inducing pathological changes in intracranial pressure or cerebral perfusion pressure.
DOI: 10.1161/str.0000000000000436
In patients with aSAH who develop severe acute respiratory distress syndrome (ARDS) and life-threatening hypoxemia, rescue maneuvers such as prone positioning and alveolar recruitment maneuvers with ICP monitoring may be reasonable to improve oxygenation.
Small RCTs now demonstrate that alveolar recruitment and prone positioning can be performed in patients with aSAH with ICP monitors to effectively increase arterial oxygen partial pressure while not leading to pathological ICP and cerebral perfusion pressure values.
View source ↗