Implications of Early Versus Late Bilateral Pulmonary Infiltrates in Patients with Aneurysmal Subarachnoid Hemorrhage View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-02

AUTHORS

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

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" (< or = 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. More... »

PAGES

20

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12028-008-9137-0

DOI

http://dx.doi.org/10.1007/s12028-008-9137-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1050590898

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/18810664


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260 schema:name Departments of Critical Care Medicine and Clinical Neurosciences, Foothills Medical Center, University of Calgary, Room EG23J, 1403 29th St. NW, T2N 2T9, Calgary, AB, Canada
261 rdf:type schema:Organization
262 https://www.grid.ac/institutes/grid.27755.32 schema:alternateName University of Virginia
263 schema:name Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
264 Departments of Neurology and Internal Medicine, University of Virginia, Charlottesville, VA, USA
265 School of Medicine, University of Virginia, Charlottesville, VA, USA
266 rdf:type schema:Organization
 




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