tailieunhanh - Báo cáo y học: "Wet lungs, broken hearts and difficult therapies after subarachnoid hemorrhage"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Wet lungs, broken hearts and difficult therapies after subarachnoid hemorrhage. | Stocchetti Critical Care 2010 14 140 http content 14 2 140 CRITICAL CARE COMMENTARY L__ Wet lungs broken hearts and difficult therapies after subarachnoid hemorrhage Nino Stocchetti See related research by Hoff etal. http content 14 2 R43 Abstract Pulmonary edema PE can occur after subarachnoid hemorrhage and can jeopardize arterial oxygenation which is essential for a suffering brain. In some cases PE is evident in the emergency room being the direct consequence of intracranial bleeding which causes an immediate and overwhelming catecholamine discharge. In the following days PE can occur because of cardiac failure often related to initial cardiac damage concurrent therapies with fluid overload and vasopressors infections or pre-existing co-morbidities. The causes of PE need to be identified for appropriate treatment. An acute catecholamine discharge immediately following intracranial bleeding can have devastating extracranial effects the heart lungs fluids and electrolytes can be severely affected. Hoff and colleagues report on pulmonary edema PE following subarachnoid hemorrhage SAH 1 . They found a high incidence of PE usually several days after the initial bleeding and an association of PE with lower intravascular volumes compared with cases without PE . PE is not uncommon after SAH both as an early complication and as a late complication. Neurogenic PE is an acute event directly linked with an intracranial disaster as such it is often diagnosed on admission in cases with severe SAH 2 . PE in the days following SAH has been reported in association with triple-H therapy which includes hypervolemia and induced arterial hypertension 3 . In different series the PE incidence varied from 14 to 23 4 5 . Increasing evidence is accumulating on the myocardial dysfunction that follows SAH as well as other acute intracranial Correspondence stocchet@ Milan University Terapia Intensiva Neuroscienze Fondazione IRCCS Ca Granda