INTRACRANIAL HYPERTENSION AND ADULT-RESPIRATORY-DISTRESS-SYNDROME - USEFULNESS OF TRACHEAL GAS INSUFFLATION

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