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Dialysis disequilibrium syndrome in neurointensive care unit: the benefit of intracranial pressure monitoring.

Esnault P, Lacroix G, Cungi PJ, D'Aranda E, Cotte J, Goutorbe P - Crit Care (2012)

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Dialysis disequilibrium syndrome (DDS) is a brain disease characterized by neurological symptoms due to cerebral edema after hemodialysis (HD)... At day 4, toxic acute renal failure appeared... Fearing the occurrence of a DDS, we used continuous veno-venous hemofiltration (CVVH), which allowed a gradual reduction in urea without an intracranial hypertension (ICH) episode... After HD was stopped, osmotherapy was administered, and neurosedation was increased, ICP returned to normal (Figure 1)... Afterward, we successfully used CVVH without a new episode of ICH... This case is didactic because, as we monitored the ICP, we saw the consequences of DDS on the brain... This technique allows gradual osmotic movement and minimizes the gradient between blood and cerebrospinal fluid... In conclusion, in the intensive care unit, DDS should be considered at each alteration of consciousness during an HD... We suggest that CVVH be used in predisposed patients to minimize the risk of DDS... CVVH: continuous veno-venous hemofiltration; DDS: dialysis disequilibrium syndrome; HD: hemodialysis; ICH: intracranial hypertension; ICP: intracranial pressure... The authors declare that they have no competing interests.

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Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) during a five-and-a-half-hour time period. Intracranial hypertension was noted at 11:40 a.m., one hour after the start of hemodialysis (HD). Intracranial hypertension at 12:30 p.m. was due to hypotension after increased neurosedation and at 1:30 p.m. was due to hypercapnia (50 mm Hg) after a change of ventilation mode (from assisted spontaneous breathing to synchronized controlled mechanical ventilation).
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Figure 1: Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) during a five-and-a-half-hour time period. Intracranial hypertension was noted at 11:40 a.m., one hour after the start of hemodialysis (HD). Intracranial hypertension at 12:30 p.m. was due to hypotension after increased neurosedation and at 1:30 p.m. was due to hypercapnia (50 mm Hg) after a change of ventilation mode (from assisted spontaneous breathing to synchronized controlled mechanical ventilation).

Mentions: A 51-year-old man was admitted for severe traumatic brain injury. At admission, an extradural hematoma was evacuated. After surgery, ICP monitoring guided the treatment. At day 4, toxic acute renal failure appeared. Fearing the occurrence of a DDS, we used continuous veno-venous hemofiltration (CVVH), which allowed a gradual reduction in urea without an intracranial hypertension (ICH) episode. Later, after a resumption of diuresis, we stopped CVVH. At day 11, urea increased to 35.6 mmol/L and creatininemia to 452 μmol/L. Serum sodium was 145 mmol/L. Because the trauma had occurred several days before, we decided to perform HD. One hour after the start of HD, an ICH appeared (ICP = 37 mm Hg). Urea was 22.3 mmol/L and serum sodium was 144 mmol/L (unchanged). DDS was diagnosed. After HD was stopped, osmotherapy was administered, and neurosedation was increased, ICP returned to normal (Figure 1). Afterward, we successfully used CVVH without a new episode of ICH. At day 19, the patient was discharged and later made a full recovery.


Dialysis disequilibrium syndrome in neurointensive care unit: the benefit of intracranial pressure monitoring.

Esnault P, Lacroix G, Cungi PJ, D'Aranda E, Cotte J, Goutorbe P - Crit Care (2012)

Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) during a five-and-a-half-hour time period. Intracranial hypertension was noted at 11:40 a.m., one hour after the start of hemodialysis (HD). Intracranial hypertension at 12:30 p.m. was due to hypotension after increased neurosedation and at 1:30 p.m. was due to hypercapnia (50 mm Hg) after a change of ventilation mode (from assisted spontaneous breathing to synchronized controlled mechanical ventilation).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3672609&req=5

Figure 1: Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) during a five-and-a-half-hour time period. Intracranial hypertension was noted at 11:40 a.m., one hour after the start of hemodialysis (HD). Intracranial hypertension at 12:30 p.m. was due to hypotension after increased neurosedation and at 1:30 p.m. was due to hypercapnia (50 mm Hg) after a change of ventilation mode (from assisted spontaneous breathing to synchronized controlled mechanical ventilation).
Mentions: A 51-year-old man was admitted for severe traumatic brain injury. At admission, an extradural hematoma was evacuated. After surgery, ICP monitoring guided the treatment. At day 4, toxic acute renal failure appeared. Fearing the occurrence of a DDS, we used continuous veno-venous hemofiltration (CVVH), which allowed a gradual reduction in urea without an intracranial hypertension (ICH) episode. Later, after a resumption of diuresis, we stopped CVVH. At day 11, urea increased to 35.6 mmol/L and creatininemia to 452 μmol/L. Serum sodium was 145 mmol/L. Because the trauma had occurred several days before, we decided to perform HD. One hour after the start of HD, an ICH appeared (ICP = 37 mm Hg). Urea was 22.3 mmol/L and serum sodium was 144 mmol/L (unchanged). DDS was diagnosed. After HD was stopped, osmotherapy was administered, and neurosedation was increased, ICP returned to normal (Figure 1). Afterward, we successfully used CVVH without a new episode of ICH. At day 19, the patient was discharged and later made a full recovery.

View Article: PubMed Central - HTML - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dialysis disequilibrium syndrome (DDS) is a brain disease characterized by neurological symptoms due to cerebral edema after hemodialysis (HD)... At day 4, toxic acute renal failure appeared... Fearing the occurrence of a DDS, we used continuous veno-venous hemofiltration (CVVH), which allowed a gradual reduction in urea without an intracranial hypertension (ICH) episode... After HD was stopped, osmotherapy was administered, and neurosedation was increased, ICP returned to normal (Figure 1)... Afterward, we successfully used CVVH without a new episode of ICH... This case is didactic because, as we monitored the ICP, we saw the consequences of DDS on the brain... This technique allows gradual osmotic movement and minimizes the gradient between blood and cerebrospinal fluid... In conclusion, in the intensive care unit, DDS should be considered at each alteration of consciousness during an HD... We suggest that CVVH be used in predisposed patients to minimize the risk of DDS... CVVH: continuous veno-venous hemofiltration; DDS: dialysis disequilibrium syndrome; HD: hemodialysis; ICH: intracranial hypertension; ICP: intracranial pressure... The authors declare that they have no competing interests.

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Related in: MedlinePlus