Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a common problem faced by patients in the intensive care unit (ICU). The etiology of ALI is multifactorial and depends on the clinical situation; frequently ALI is the manifestation of bilateral pneumonia, transfusion reactions, or aspiration. This chapter presents a case study of a 26-year-old female who was admitted for confusion, continuing headache, nausea, and vomiting. There are two different etiological categories of ALI: direct lung injury and indirect lung injury. Direct lung injury tends to include pneumonia and aspiration along with inhalational injury and pulmonary contusions. Indirect injury etiology includes sepsis, trauma, blood transfusions, and pancreatitis. The use of positive end expiratory pressure (PEEP) and low tidal volume ventilation in the neurosurgical population is problematic, as a key component of ventilator management in this population is appropriate CO2 removal.

Sitting craniotomies pose a unique set of problems for perioperative care of the neurosurgical patient. Although there are benefits to neurosurgery in this position, a number of potentially catastrophic complications may also result. This chapter presents a case study of a 20-year-old morbidly obese male presented for resection of a pineocytoma via a supracerebellar approach in the sitting position. The sitting position for craniotomies offers several surgical advantages. Exposure to posterior cervical and posterior fossa structures is improved. It has been suggested that a ventriculo-atrial shunt, pulmonary hypertension, a patent foramen ovale, and symptomatic cerebral ischemia may be absolute contraindications to this procedure. Performing surgery in the sitting position for patients with uncontrolled hypertension, significant chronic obstructive airway disease, or at the extremes of age should also be done with caution. However, there are few data to support appropriate patient selection.