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SAH may be accompanied by significant pulmonary, cardiovascular, or endocrine effects.
Pulmonary compro- mise is often seen in neurologic patients with altered mental status due to impaired airway reflexes and repeated aspira- tion episodes, which culminate in a significant incidence of pneumonia, irrespective of the initiating pathologic pro- cess.15,16 Another potential mechanism is the release of cytokines from the brain in response to the inflammatory process triggered by an injury.
Up to 25% of patients with isolated TBI develop deep vein thrombosis (DVT) with the risk of pulmonary embolism.131 Low-molecular-weight heparin or low-dose unfractionated heparin should be used in combination with mechanical prophylaxis, despite the increased risk of intracranial hemorrhage expansion.24 The Parkland Protocol, which stratifies patients into dif- ferent risk groups for spontaneous progression of hemor- rhage, can help assess the optimal timing for the start of DVT prophylaxis.132 The incidence of early posttraumatic seizures (during the first week after TBI) can be reduced by phenytoin.24 As these early posttraumatic seizures do not influence outcome, this prevention is not obligatory.
Weaning should be started early and if it is complicated, the patient should receive a tracheostomy to reduce mechanical ven- tilation days, decrease the need for sedation, and facilitate pulmonary toilet.
Neurogenic Cardiac and Pulmonary Disturbances.،SAH may be accompanied by significant pulmonary, cardiovascular, or endocrine effects.
Pulmonary compro- mise is often seen in neurologic patients with altered mental status due to impaired airway reflexes and repeated aspira- tion episodes, which culminate in a significant incidence of pneumonia, irrespective of the initiating pathologic pro- cess.15,16 Another potential mechanism is the release of cytokines from the brain in response to the inflammatory process triggered by an injury.
Up to 25% of patients with isolated TBI develop deep vein thrombosis (DVT) with the risk of pulmonary embolism.131 Low-molecular-weight heparin or low-dose unfractionated heparin should be used in combination with mechanical prophylaxis, despite the increased risk of intracranial hemorrhage expansion.24 The Parkland Protocol, which stratifies patients into dif- ferent risk groups for spontaneous progression of hemor- rhage, can help assess the optimal timing for the start of DVT prophylaxis.132 The incidence of early posttraumatic seizures (during the first week after TBI) can be reduced by phenytoin.24 As these early posttraumatic seizures do not influence outcome, this prevention is not obligatory.
Weaning should be started early and if it is complicated, the patient should receive a tracheostomy to reduce mechanical ven- tilation days, decrease the need for sedation, and facilitate pulmonary toilet.
Neurogenic Cardiac and Pulmonary Disturbances.،Acute chest syndrome (ACS) is believed to represent a combination of pneumonia, pulmonary infarction, and pulmonary emboli from necrotic bone marrow.
overload, and, in adulthood, pulmonary hypertension are also commonly
Consider exchange transfusion for patients with rapid progression of ACS, with saturation <90% despite oxygen, increasing respiratory dis- tress, progressive pulmonary infiltrates, or a declining Hgb despite transfusion.
diffuse pulmonary infiltrates and
spread inflammation secondary to sepsis commonly affects pulmonary function even in the absence of pneumonia.
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