title: Acute respiratory distress syndrome after spontaneous intracerebral hemorrhage*.
abstract: OBJECTIVE
  Acute respiratory distress syndrome develops commonly in critically ill patients in response to an injurious stimulus. The prevalence and risk factors for development of acute respiratory distress syndrome after spontaneous intracerebral hemorrhage have not been reported. We sought to determine the prevalence of acute respiratory distress syndrome after intracerebral hemorrhage, characterize risk factors for its development, and assess its impact on patient outcomes.
  
  
  METHODS
  Retrospective cohort study at two academic centers.
  
  
  METHODS
  We included consecutive patients presenting from June 1, 2000, to November 1, 2010, with intracerebral hemorrhage requiring mechanical ventilation. We excluded patients with age less than 18 years, intracerebral hemorrhage secondary to trauma, tumor, ischemic stroke, or structural lesion; if they required intubation only during surgery; if they were admitted for comfort measures; or for a history of immunodeficiency.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data were collected both prospectively as part of an ongoing cohort study and by retrospective chart review. Of 1,665 patients identified by database query, 697 met inclusion criteria. The prevalence of acute respiratory distress syndrome was 27%. In unadjusted analysis, high tidal volume ventilation was associated with an increased risk of acute respiratory distress syndrome (hazard ratio, 1.79 [95% CI, 1.13-2.83]), as were male sex, RBC and plasma transfusion, higher fluid balance, obesity, hypoxemia, acidosis, tobacco use, emergent hematoma evacuation, and vasopressor dependence. In multivariable modeling, high tidal volume ventilation was the strongest risk factor for acute respiratory distress syndrome development (hazard ratio, 1.74 [95% CI, 1.08-2.81]) and for inhospital mortality (hazard ratio, 2.52 [95% CI, 1.46-4.34]).
  
  
  CONCLUSIONS
  Development of acute respiratory distress syndrome is common after intubation for intracerebral hemorrhage. Modifiable risk factors, including high tidal volume ventilation, are associated with its development and in-patient mortality.
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburg, PA, USA. elmerjp@upmc.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elmer
authors.forename: Peter
authors.initials: P
authors.lastname: Hou
authors.forename: Susan R
authors.initials: SR
authors.lastname: Wilcox
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Hannah
authors.initials: H
authors.lastname: Schreiber
authors.forename: Ikenna
authors.initials: I
authors.lastname: Okechukwu
authors.forename: Octávio
authors.initials: O
authors.lastname: Pontes-Neto
authors.forename: Ednan
authors.initials: E
authors.lastname: Bajwa
authors.forename: Dean R
authors.initials: DR
authors.lastname: Hess
authors.forename: Laura
authors.initials: L
authors.lastname: Avery
authors.forename: Maria Alejandra
authors.initials: MA
authors.lastname: Duran-Mendicuti
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pallin
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000150:complications*; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000150:complications; D007362:Intensive Care Units; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications; D013990:Tidal Volume; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D055397:Ventilator-Induced Lung Injury / Q000150:complications*; D014882:Water-Electrolyte Balance
chemical_list: D010975:Platelet Aggregation Inhibitors; D014662:Vasoconstrictor Agents; D001241:Aspirin