Systemic (Non-neurological) Complications in the Neurocritical Patient

Non-neurological complications in neurocritical patients include cardiovascular, pulmonary, endocrine-metabolic, and renal dysfunction in its multiple degrees and electrolyte and coagulation disorders. They can result from the primary neurological injury itself or the established treatment. Twenty-six percent of these patients may have some injury degree or systemic organ dysfunction. These conditions increase mortality by 31 percent when they involve a single system, 91 percent when two of them are concerned, and reaching 100 percent when there are three failed systems. Non-neurological dysfunction is related to a massive increase in catecholamines released by damage to the central nervous system. They will act on the cardiovascular system leading in diverse presentations, from arrhythmia to a picture of left ventricular dysfunction that needs vasoactive drugs or circulatory assistance. This massive catecholamine release can also result in lung infection by bronchial aspiration due to a lack of airway protection, as well as acute non-cardiogenic lung edema. Intensive treatment aims to maintain cerebral perfusion pressure higher than 60 mmHg. Renal dysfunction could be presented due to arterial hypotension, hypovolemic shock, or polytrauma with rhabdomyolysis due to muscle damage or might be related to contrast for diagnosis of contrast image. Finally, by using propofol sedation, we can have the undesired propofol syndrome.