Pulmonary Complications of Aneurysmal Subarachnoid Hemorrhage

作者：Jonathan A. Friedman, Mark A. Pichelmann, David G. Piepgras, Jon I. McIver, L. Gerard Toussaint, Robyn L. McClelland, Douglas A. Nichols, Fredric B. Meyer, John L. D. Atkinson, Eelco F. M. Wijdicks · 发表于：Neurosurgery · 年份：2003 · DOI：10.1227/01.neu.0000058222.59289.f1 · 被引用次数：175 · 研究领域：Intracranial Aneurysms: Treatment and Complications、Intracerebral and Subarachnoid Hemorrhage Research、Takotsubo Cardiomyopathy and Associated Phenomena

OBJECTIVE: Pulmonary complications challenge the medical management of patients who have sustained aneurysmal subarachnoid hemorrhage (SAH). We assessed the frequency and types of pulmonary complications after aneurysmal SAH and analyzed the impact of pulmonary complications on patient outcome. METHODS: We reviewed the records of all patients with acute SAH treated at our institution between 1990 and 1997. Three hundred five consecutive patients with an aneurysmal hemorrhage source documented by angiography and treated within 7 days of ictus were analyzed. Outcomes at longest follow-up (mean, 16 mo) were measured by use of the Glasgow Outcome Scale. RESULTS: Pulmonary complications were documented in 66 patients (22%). The pulmonary complications were nosocomial pneumonia in 26 patients (9%), congestive heart failure in 23 (8%), aspiration pneumonia in 17 (6%), neurogenic pulmonary edema in 5 (2%), pulmonary embolus in 2 (<1%), and other pulmonary disorders in 4 (1%); 11 patients had two pulmonary complications. The incidence of symptomatic vasospasm was greater in patients with pulmonary complications (63%) than in patients without pulmonary complications (31%) (P = 0.001), and this association was independent of age and clinical grade at admission (odds ratio, 3.68; P < 0.001). Overall clinical outcomes were worse in patients with pulmonary complications (mean Glasgow Outcome Scale score, 3.3) than in patients without pulmonary complications (mean Glasgow Outcome Scale scor...