Skip to main content Accessibility help
  • Print publication year: 2011
  • Online publication date: May 2011

Case 75 - Mechanicalventilation

from Section II - Neurocritical care


Patients who are refractory to medical management can be candidates for surgical treatment such as anatomical or functional hemispherectomy. This chapter presents a case study of a 10-month-old male with left-sided hemiparesis. The patient subsequently developed seizures refractory to medical treatment and presented for a right functional hemispherectomy. Postoperatively, antithrombin III (ATIII) levels were checked twice daily and infusions of thrombate III were dosed accordingly. Early surgery for intractable epilepsy is recommended as it has been shown to improve functional outcomes. Anatomic hemispherectomy consists of the resection of the frontal, parietal and occipital cortices, complete temporal lobectomy and insular resection. Perioperative complications associated with this procedure include significant changes in systemic and pulmonary vascular resistance, arrhythmias, cardiac arrest, neurogenic pulmonary edema, seizures, cerebral edema, massive blood loss, and coagulopathy. Patients undergoing hemispherectomy are usually on chronic anticonvulsant therapy.


1. R. L. Chatburn. Classification of ventilator modes: update and proposal for implementation. Respir Care 2007; 52: 301–23.
2. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000; 342: 1301–8.
3. N. R. MacIntyre, D. J. Cook, E. W. Ely, Jr et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001; 120: 375S-95S.
4. E. Muench, C. Bauhuf, H. Roth et al. Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation. Crit Care Med 2005; 33: 2367–72.