Acute Respiratory Distress Syndrome in Patients with Intracerebral Hemorrhage.

Introduction: Patients with an intracerebral hemorrhage (ICH) have been shown to have a high incidence of acute respiratory distress syndrome (ARDS). We aimed to determine the incidence of ARDS following ICH in the era of lung-protective ventilation. We also examined risk factors associated with ARDS following ICH. Materials and Methods: A retrospective cohort study of adults admitted to a single health system's intensive care units with acute, spontaneous ICH from 1 March 2015 to 28 February 2018, using univariate and multivariable logistic regression models to evaluate the associations of patient characteristics with the diagnosis of ARDS. Results: In total, 269 patients were included, with 155 patients requiring invasive mechanical ventilation. The overall incidence of ARDS was 6.7% (18/269), and the incidence in intubated patients was 10% (16/155), as the median time of ventilation with >8 cc/mL of ideal body weight was low. For the entire ICH population, severity of hypoxemia on initial arterial blood gas (ABG; Odds Ratio [OR] per 10 mmHg 0.855 [95% Confidence Interval [CI] 0.74-0.987]) and total minutes of mechanical ventilation (OR per 60 min 1.018 [95% CI 1.007-1.029]) were both associated with the diagnosis of ARDS. In intubated patients, ventilation, younger age (OR per 10 years 0.655 [95% CI 0.431-0.997]), and total minutes of mechanical ventilation (OR per 60 min 1.028 [95% CI 1.006-1.049] increased the odds of developing ARDS. Conclusions: ARDS was found to be significantly lower in the present cohort of ICH patients when compared to prior studies, with younger age and hypoxemia associated with an increasing risk.

Duke Scholars

Author Vijay Krishnamoorthy Anesthesiology, Critical Care Medicine

Author Shreyansh Shah Neurology, Neurocritical Care

Author Jordan Komisarow Neurosurgery

Author Michael Lucas James Anesthesiology, Neuroanesthesia