Weaning from mechanical ventilation in the patient with post-hypoxic encephalopathy and central hyperthermia
Background. Post-hypoxic injury of the central nervous system might lead to multiple organ dysfunction syndrome, persistent neurological impairment and be complicated by central hyperthermia. The aim of this study was to analyze the published data on central hyperthermia and present the clinical case of successful treatment of central hyperthermia and weaning from mechanical ventilation in the patient with post-hypoxic encephalopathy. Materials and methods. We analyzed the data from PubMed and MedLine databases (using the key words “central hyperthermia” and “weaning from mechanical ventilation in children with post-hypoxic encephalopathy”) for the last 13 years. In September 2018, our patient was admitted to Lviv Regional Clinical Hospital “OHMATDYT”, which is the clinical base of the Department of Anesthesiology and Intensive Care of Danylo Halytsky Lviv National Medical University. Results. We present a clinical case of post-hypoxic encephalopathy, multiple organ dysfunction syndrome and central hyperthermia (above 39 C) in a 7-month-old child survived after clinical death. In this case, central hyperthermia led to increased spontaneous minute volume ventilation, oxygen consumption and tachycardia and, as a result, to difficult weaning from mechanical ventilation. Moreover, this patient had clinically significantly increased muscle tone in lower extremities with hyperextension in hip joints (more than 180°). We started with baclofen administration at a dose of 0.3 mg/kg/day and raised the dose to 0.6 mg/kg/day at day 7. On day 3, the patient’s body temperature dropped to 38 °C and on day 5 it was no more than 37.5 °C. We weaned our patient from mechanical ventilation step by step: start from synchronized intermittent mandatory ventilation mode with decreasing the parameters every day, then continue with pressure support ventilation and start from 2–4 ventilator-free hours at day time during 2–3 days, then from day to day increase this ventilator-free time and provide mechanical ventilation only at night. Complete weaning was performed on day 7 from the baclofen treatment initiation. Conclusions. Hyperthermia control in patients with central nervous system injury might improve the treatment outcome, especially if more effective strategies for monitoring and treating hyperthermia will be developed and introduced in daily routine clinical practice.
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