Acute lung injury in patients with subarachnoid hemorrhage: Incidence, risk factors, and outcome
Acute lung injury in patients with subarachnoid hemorrhage: Incidence, risk factors, and outcome
复制标题
DOI：
10.1097/01.ccm.0000194540.44020.8e
复制
发表时间：
2006-01-01
影响因子：
8.8
通讯作者：
Rubenfeld, GD
中科院分区：
文献类型：
--
作者：
Kahn, JM;Caldwell, EC;Rubenfeld, GD
目的：肺部并发症是蛛网膜下腔出血后发病率和死亡率的重要原因，然而，急性肺损伤的影响在很大程度上尚不清楚。本研究的目的是确定一个大型蛛网膜下腔出血患者队列中急性肺损伤的发生率，并确定急性肺损伤的危险因素及其对死亡率和住院时间的影响。对呼吸机管理进行分析，以确定接受低潮气量通气策略的蛛网膜下腔出血和急性肺损伤患者的比例。设计：回顾性队列研究。设置：华盛顿州西雅图的大学附属县医院。患者：620例经计算机断层扫描或血管造影证实的蛛网膜下腔出血患者。干预：无。测量和主要结果：170名患者符合急性肺损伤标准（发生率，27%; 95%置信区间，24-31%）。多变量分析显示，重症监护室中的疾病严重程度、出血的临床分级、浓缩红细胞输注和严重脓毒症与急性肺损伤的发生独立相关。校正重要混杂因素后，急性肺损伤的发生与住院死亡率的统计学显著增加相关（比值比，1.63; 95%可信区间，1.03-2.57）。急性肺损伤也与重症监护室住院时间延长独立相关（15%，95%置信区间，5-27%）。30%的急性肺损伤患者接受低潮气量通气。与未接受低潮气量通气的患者相比，接受低潮气量通气的患者氧合更差，呼气末正压要求更高，但动脉pH值或P-CO2无显著差异。结论：急性肺损伤在蛛网膜下腔出血患者中很常见，与更差的临床结局独立相关。需要进行研究以确定这一人群中急性肺损伤的原因，以及这些患者是否适合采用循证呼吸机策略以降低死亡率。
Objective: Pulmonary complications account for significant morbidity and mortality following aneurysmal subarachnoid hemorrhage; however, the effect of acute lung injury is largely unknown. The goal of this study was to determine the incidence of acute lung injury in a large cohort of patients with subarachnoid hemorrhage as well as determine the risk factors for acute lung injury and its effect on mortality and length of stay. Ventilator management was analyzed to determine the proportion of patients with subarachnoid hemorrhage and acute lung injury who a received a low-tidal volume ventilation strategy.Design: Retrospective cohort study.Setting: University-affiliated county hospital in Seattle, WA.Patients: Six-hundred and twenty patients with aneurysmal subarachnoid hemorrhage documented on computed tomography or angiography.Interventions; None.Measurements and Main Results: One-hundred and seventy patients met criteria for acute lung injury (incidence, 27%; 95% confidence interval, 24-31%). On multivariate analysis, severity of illness, clinical grade of hemorrhage, packed red blood cell transfusions, and severe sepsis in the intensive care unit were independently associated with development of acute lung injury. After adjustment for important confounders, development of acute lung injury was associated with a statistically significant increase in hospital mortality (odds ratio, 1.63; 95% confidence interval, 1.03-2.57). Acute lung injury was also independently associated with an increased intensive care unit length of stay (15%, 95% confidence interval, 5-27%). Thirty percent of patients with acute lung injury received low tidal volume ventilation. Patients receiving low tidal volume ventilation had worse oxygenation and higher positive end-expiratory pressure requirements compared with those who did not, but there were no significant differences in arterial pH or P-CO2.Conclusions: Acute lung injury is common in patients with subarachnoid hemorrhage and is independently associated with a worse clinical outcome. Research is needed to determine the causes of acute lung injury in this population and whether these patients are candidates for evidence-based ventilator strategies to reduce mortality.