1. Controversial treatment of a victim of severe head injury complicated by septic shock and acute respiratory distress syndrome
- Author
-
Lars J Bjertnaes, null Haavind, null Hevroy, and null Hennig
- Subjects
ARDS ,medicine.medical_specialty ,business.industry ,Septic shock ,Head injury ,activated protein C ,VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Traumatology: 783 ,Case Report ,General Medicine ,acute respiratory distress syndrome ,medicine.disease ,severe head injury ,Surgery ,Head trauma ,Pneumonia ,Blood pressure ,VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Traumatologi: 783 ,Anesthesia ,medicine ,Breathing ,septic shock ,business ,Intracranial pressure - Abstract
Pneumonia, severe sepsis, and acute respiratory distress syndrome (ARDS) are frequent complications after head trauma. Recombinant human activated protein C (APC) reportedly improves circulation and respiration in severe sepsis, but is contraindicated after head injury because of increased risk of intracranial bleeding. A 21-year-old man with severe head injury after a car accident was endotracheally intubated, mechanically ventilated, and hemo- dynamically stabilized before transfer to our university hospital. His condition became com- plicated with pneumonia, septic shock, ARDS, coagulation dysfunction, and renal failure. In spite of intensive therapy, oxygenation and arterial blood pressure fell to critically low values. Simultaneously, his intracranial pressure peaked and his pupils dilated, displaying no reflexes to light. His antibiotic regimen was changed and ventilation was altered to high frequency oscil- lations, and despite being ethically problematic, we added APC to his treatment. The patient recovered with modest neurological sequelae.
- Published
- 2011