36-year-old patient admitted for cerebral haemorrhage, open to the ventricles. Neurosurgical evacuation was ruled out. Initial ICP was higher than 20mmHg; sedoanalgesia, relaxation and osmotics were started. At 72h she started progressive respiratory deterioration, attributed to neurogenic pulmonary oedema. After 48h with FiO2 of 1, PD was tried on the eighth day of admission. There was no significant respiratory improvement and the ICP rose to 20mmHg. After 12h, the patient was switched back to SD. After a further 12 hours, respiratory improvement began, which allowed a decrease in FiO2 to be initiated. On the twelfth day, coinciding with a transfer to the CT room, ICP monitoring was lost and a new sensor was placed, which gave values below 20mmHg with a CPP above 65mmHg, which remained similar on the following days. Two days later, respiratory deterioration resumed. He was placed early on PD, which allowed a decrease in FiO2 in 3h. After 12h on PD, he was placed on SD and continued to improve. No deterioration in ICP or CPP was observed. Subsequent evolution was favourable until recovery of a normal level of consciousness, with left hemiparesis.

