Continuous renal replacement therapy for refractory intracranial hypertension
Jeffrey J Fletcher1, Karen Bergman, Eric C Feucht
1Department of Neurology (Neurocritical Care), Bronson Methodist Hospital, 601 John Street Suite M-124, Kalamazoo, MI 49007, USA. fletchej@bronsonhg.org
Neurocritical Care
|March 10, 2009
Summary
Continuous renal replacement therapy (CRRT) safely reduced intracranial pressure (ICP) in a severe traumatic brain injury (TBI) patient. This case suggests CRRT may benefit acute brain injury (ABI) patients with refractory intracranial hypertension.
Area of Science:
- Nephrology
- Neurology
- Critical Care Medicine
Background:
- Hemodialysis poses risks for patients with acute brain injury (ABI) due to hemodynamic effects and potential increases in intracranial pressure (ICP).
- Continuous renal replacement therapy (CRRT) is preferred for renal support in ABI patients, but safety data and efficacy in managing cerebral edema are limited.
- CRRT offers a theoretical advantage in managing hypervolemia and improving intracranial compliance.
Observation:
- A severe traumatic brain injury (TBI) patient with refractory intracranial hypertension (IH) was treated with continuous hemofiltration.
- The patient required significant volume resuscitation and experienced complications including shock and ARDS.
Findings:
- Initiation of continuous hemofiltration led to a rapid improvement and normalization of ICP.
- Hemofiltration was safely discontinued after 48 hours.
- The patient achieved a modified Rankin Score of 2 at 90 days.
Implications:
- CRRT may be a beneficial treatment for intracranial hypertension in acute brain injury patients due to its gentle fluid and solute removal.
- Further case reports and studies are encouraged to validate the safety and efficacy of CRRT in managing ABI.
- This case highlights CRRT as a potential therapeutic option for refractory intracranial hypertension in TBI.
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