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Ventriculopleural shunt obstruction and positive-pressure ventilation. Case report
V L Chiang1, M Torbey, D Rigamonti
1Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Journal of Neurosurgery
|July 17, 2001
Summary
Positive-pressure ventilation can obstruct ventriculopleural shunts in low-pressure hydrocephalus patients, causing coma. Adjusting ventilation pressure reversed the obstruction and coma, highlighting the importance of monitoring intrapleural pressure effects.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Respiratory Therapy
Background:
- Low-pressure hydrocephalus (LPH) management often involves shunts to drain cerebrospinal fluid (CSF).
- Ventriculopleural shunts connect the ventricles to the pleural space for CSF diversion.
Observation:
- A patient with LPH and a ventriculopleural shunt developed shunt obstruction and coma during positive-pressure ventilation.
- Positive-pressure ventilation increased intrapleural pressure, impeding CSF flow through the shunt.
Findings:
- External CSF drainage at subatmospheric pressure, combined with positive-pressure ventilation, normalized ventricle size and reversed coma.
- Removing positive-pressure ventilation restored CSF flow and resolved the patient's coma.
Implications:
- Clinicians must consider the impact of positive-pressure ventilation on intrapleural pressure and ventriculopleural shunt function.
- Careful management of ventilation is crucial in patients with ventriculopleural shunts to prevent complications.
- This case underscores the need for individualized respiratory support strategies in neurosurgical patients.