# Acute Respiratory Distress Syndrome in Patients with Intracerebral Hemorrhage

## TL;DR

This study found that about 6.7% of patients with brain bleeds develop lung failure, with younger age and low blood oxygen levels increasing the risk.

## Contribution

The study reports a lower incidence of ARDS in ICH patients compared to prior studies and identifies specific risk factors in the era of lung-protective ventilation.

## Key findings

- The overall incidence of ARDS in ICH patients was 6.7%, lower than previously reported.
- Younger age and initial hypoxemia were significant risk factors for ARDS in ICH patients.
- Prolonged mechanical ventilation increased the odds of ARDS in both the overall and intubated ICH populations.

## Abstract

Introduction: Patients with an intracerebral hemorrhage (ICH) have been shown to have a high incidence of acute respiratory distress syndrome (ARDS). We aimed to determine the incidence of ARDS following ICH in the era of lung-protective ventilation. We also examined risk factors associated with ARDS following ICH. Materials and Methods: A retrospective cohort study of adults admitted to a single health system’s intensive care units with acute, spontaneous ICH from 1 March 2015 to 28 February 2018, using univariate and multivariable logistic regression models to evaluate the associations of patient characteristics with the diagnosis of ARDS. Results: In total, 269 patients were included, with 155 patients requiring invasive mechanical ventilation. The overall incidence of ARDS was 6.7% (18/269), and the incidence in intubated patients was 10% (16/155), as the median time of ventilation with >8 cc/mL of ideal body weight was low. For the entire ICH population, severity of hypoxemia on initial arterial blood gas (ABG; Odds Ratio [OR] per 10 mmHg 0.855 [95% Confidence Interval [CI] 0.74–0.987]) and total minutes of mechanical ventilation (OR per 60 min 1.018 [95% CI 1.007–1.029]) were both associated with the diagnosis of ARDS. In intubated patients, ventilation, younger age (OR per 10 years 0.655 [95% CI 0.431–0.997]), and total minutes of mechanical ventilation (OR per 60 min 1.028 [95% CI 1.006–1.049] increased the odds of developing ARDS. Conclusions: ARDS was found to be significantly lower in the present cohort of ICH patients when compared to prior studies, with younger age and hypoxemia associated with an increasing risk.