A 17-year-old male with severe TBI, apnea pauses and severe ARF at the site of the accident.
The initial computed tomography (CT) showed no abnormalities; the control at 24h, minimal epidural hematoma and hemorrhagic petechiae in the cuadrigeminal lamina.
During the first days, several doses of osmotic agents are required for ICH, with favorable results.
She was respiratoryly and hemodynamically stable with minimal amine requirements.
From the sixth day on, the patient presented progressive deterioration of respiratory function in relation to ventilator-associated pneumonia (VAP).
The ninth day is placed on PD.
We observed an initial elevation in ICP up to 28mmHg, which was rapidly achieved with mannitol.
Osmotic administration is necessary on two other occasions, with adequate response.
Progressive improvement in FiO2 allows us to lower FiO2.
PD is maintained for 16h.
Subsequently, the patient is placed in the supine position (SD), with no deterioration in gas exchange, which improves until its definitive normalization.
His neurological outcome is favorable.
The patient is discharged from our conscious unit with left brachial paresis, which is completely recovered later.
