Implications of early versus late bilateral pulmonary infiltrates in patients with aneurysmal subarachnoid hemorrhage

Andreas H. Kramer, Thomas P. Bleck, Aaron S. Dumont, Neal F. Kassell, Claire Olson, Bart Nathan

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Introduction: Bilateral pulmonary infiltrates occur frequently following aneurysmal subarachnoid hemorrhage (SAH), and may be associated with worse outcomes. The etiology, natural history, and prognosis of infiltrates occurring soon after SAH may differ from the characteristics of infiltrates developing at a later time. Methods: We performed a retrospective cohort study involving 245 consecutive patients with a ruptured cerebral aneurysm to assess the association between "early" (72 h) or "late" (>72 h) bilateral pulmonary infiltrates and subsequent death or neurologic impairment. We used logistic regression models to adjust for baseline differences in age, level of consciousness, amount of blood on computed tomography, and the presence or absence of clinical vasospasm. Results: Sixty-seven patients (27%) developed bilateral pulmonary infiltrates. Of these, 36 (54%) had early infiltrates, 24 (36%) had late infiltrates, and 7 (10%) had both. Twenty-eight patients (11% of entire cohort) met criteria for acute respiratory distress syndrome (ARDS). Patients with early infiltrates were more likely to have presented with stupor or coma than patients who developed infiltrates later (64% vs. 29%, P < 0.01). In multivariable analysis, late pulmonary infiltrates were strongly predictive of poor outcome (OR 5.0, 95% CI 1.9-13.6, P < 0.01), while early infiltrates were not (OR 1.2, 95% CI 0.5-3.0, P = 0.66). Conclusions: Bilateral pulmonary infiltrates after SAH most often occur within three days of aneurysm rupture. However, only infiltrates occurring beyond this time are independently associated with poor outcome. Increased emphasis on the prevention of late pulmonary complications has the potential to improve outcomes in SAH.

Original languageEnglish (US)
Pages (from-to)20-27
Number of pages8
JournalNeurocritical Care
Volume10
Issue number1
DOIs
StatePublished - Feb 1 2009

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Neurogenic pulmonary edema
  • Neurogenic stress cardiomyopathy
  • Pulmonary edema
  • Pulmonary infiltrates
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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