title: Neurogenic pulmonary edema in patients with nontraumatic intracerebral hemorrhage: predictors and association with outcome.
abstract: BACKGROUND
  Neurogenic pulmonary edema (NPE) is a well-recognized phenomenon after intracranial insult. In this study, we evaluated the predictors for NPE and its association with outcome in patients with intensive care unit-treated nontraumatic intracranial hemorrhage.
  
  
  METHODS
  This was a prospective, observational clinical study in a university-level intensive care unit. Clinical characteristics, level of consciousness, and Acute Physiology and Chronic Health Evaluation (APACHE) II score were recorded on admission and the findings of primary head computed tomography were reviewed. A chest radiograph and arterial blood gas analysis were taken serially and NPE was determined as acute bilateral infiltrates in chest radiograph and hypoxemia. Echocardiography and cardiac and inflammatory markers were recorded. The 1-year outcome was assessed using the Glasgow Outcome Scale.
  
  
  RESULTS
  NPE developed in 38 (35%) of the 108 patients included. Predictors for NPE were higher APACHE II score (≥20, odds ratio 6.17, P = 0.003) and higher interleukin-6 plasma concentration (>40 pg/mL, odds ratio 5.62, P = 0.003). Of patients with 0, 1, or 2 predictors mentioned above, 4%, 37%, and 65% had NPE, respectively. NPE was associated with a higher 1-year mortality (37% vs 14%, P = 0.007, respectively), but with an unchanged functional outcome after 1 year (Glasgow Outcome Scale score 1-3, 53% vs 51%, P > 0.9).
  
  
  CONCLUSIONS
  Predictors for NPE are the severity of disease defined by APACHE II scores and higher levels of systemic inflammatory mediators. NPE is associated with a higher 1-year mortality, but not with a poorer 1-year functional outcome.
authors: Department of Anesthesiology and Intensive Care, Oulu University Hospital, PO Box 21, FIN-90029 OUH, Oulu, Finland. eija.junttila@oulu.f
authors: Eija
authors: E
authors: Junttila
authors: Tero
authors: T
authors: Ala-Kokko
authors: Pasi
authors: P
authors: Ohtonen
authors: Anne
authors: A
authors: Vaarala
authors: Ari
authors: A
authors: Karttunen
authors: Olli
authors: O
authors: Vuolteenaho
authors: Tuula
authors: T
authors: Salo
authors: Meeri
authors: M
authors: Sutinen
authors: Toni
authors: T
authors: Karhu
authors: Karl-Heinz
authors: KH
authors: Herzig
authors: Juha
authors: J
authors: Koskenkari
mesh_terms: D018806:APACHE; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis; D003244:Consciousness Disorders; D004562:Electrocardiography; D005260:Female; D005544:Forecasting; D023261:Glasgow Outcome Scale; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D007362:Intensive Care Units; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011654:Pulmonary Edema / Q000209:etiology* / Q000628:therapy; D013902:Radiography, Thoracic; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers