Impact of Acute Lung Injury and Acute Respiratory Distress Syndrome After Traumatic Brain Injury in the United States

Rincón, Fred; Ghosh, Sayantani; Dey, Saugat; Maltenfort, Mitchell; Vibbert, Matthew; Urtecho, Jacqueline; McBride, William; Moussouttas, Michael; Bell, Rodney; Ratliff, John K.; Jallo, Jack

doi:10.1227/neu.0b013e3182672ae5

Cited by 120 publications

(117 citation statements)

References 42 publications

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“…20,23,26 We also acknowledge the limitations of our study. First, our analysis is observational in nature, limiting the inferences that can be made about causal relationships.…”

Section: Discussionmentioning

confidence: 92%

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Rincón

Hunter²,

Schorr

et al. 2014

JNS

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Brain injuries from stroke and head trauma are leading causes of morbidity and death in the world. 3,27 In patients with these injuries, early fever 9 and hypothermia 13,29 (dysthermia) and the onset of systemic complications are associated with poor outcomes. Plausible theories of the underlying reasons for disturbance in thermoregulation after brain injury are based on observations in animal models. These findings suggest that potential causes of fever include damage to the hypothalamus, midbrain, or pons by enhanced sympathetic activity; acute or delayed ischemia; toxic blood metabolites; physical distortion; or inflammation.7,34 Accordingly, dysfunction of or damage to these thermoregulatory pathways is common in patients with brain injuries, putting them at increased risk for dysthermia. 7,30,34 Because dysthermia is known to be associated with poor outcomes in all forms Object. Fever and hypothermia (dysthermia) are associated with poor outcomes in patients with brain injuries. The authors sought to study the epidemiology of dysthermia on admission to the intensive care unit (ICU) and the effect on in-hospital case fatality in a mixed cohort of patients with brain injuries.Methods. The authors conducted a multicenter retrospective cohort study in 94 ICUs in the United States. Critically ill patients with neurological injuries, including acute ischemic stroke (AIS), aneurysmal subarachnoid hemorrhage (aSAH), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI), who were older than 17 years and consecutively admitted to the ICU from 2003 to 2008 were selected for analysis.Results. In total, 13,587 patients were included in this study; AIS was diagnosed in 2973 patients (22%), ICH in 4192 (31%), aSAH in 2346 (17%), and TBI in 4076 (30%). On admission to the ICU, fever was more common among TBI and aSAH patients, and hypothermia was more common among ICH patients. In-hospital case fatality was more common among patients with hypothermia (OR 12.7,) than among those with fever (OR 1.9, 95% CI 1.7-2.1). Compared with patients with ICH (OR 2.0, 95% CI 1.8-2.3), TBI (OR 1.5, 95% CI 1.3-1.8), and aSAH (OR 1.4, 95% CI 1.2-1.7), patients with AIS who developed fever had the highest risk of death (OR 3.1, 95% CI 2.5-3.7). Although all hypothermic patients had an increased mortality rate, this increase was not significantly different across subgroups. In a multivariable analysis, when adjusted for all other confounders, exposure to fever (adjusted OR 1.3, 95% CI 1.1-1.5) or hypothermia (adjusted OR 7.8, 95% CI 3.9-15.4) on admission to the ICU was found to be significantly associated with in-hospital case fatality.Conclusions. Fever is frequently encountered in the acute phase of brain injury, and a small proportion of patients with brain injuries may also develop spontaneous hypothermia. The effect of fever on mortality rates differed by neurological diagnosis. Both early spontaneous fever and hypothermia conferred a higher risk of in-hospital death after brain injury. Abbreviations used in this paper: AIS ...

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“…20,23,26 We also acknowledge the limitations of our study. First, our analysis is observational in nature, limiting the inferences that can be made about causal relationships.…”

Section: Discussionmentioning

confidence: 92%

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Rincón

Hunter²,

Schorr

et al. 2014

JNS

Self Cite

View full text Add to dashboard Cite

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“…In previous reports, ARDS occurs in up to 20-38% of cases of subarachnoid haemorrhage [13][14][15], traumatic brain injury [1,16] and spontaneous intracerebral haemorrhage [4,5,17,18], and 35% reported in a mixed cohort of neurologically ill patients [19]. Variability in ARDS incidence may reflect differences in study populations and in diagnosis approach, variable use of consensus approach.…”

Section: Discussionmentioning

confidence: 95%

Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

Tejerina

Pelosi

Muriel

et al. 2017

Journal of Critical Care

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a b s t r a c t a r t i c l e i n f oPurpose: In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury. Materials and methods: We performed a secondary analysis of a prospective, observational study on mechanical ventilation. Results: We included 986 patients mechanically ventilated due to an acute brain injury (hemorrhagic stroke, ischemic stroke or brain trauma). Incidence of ARDS in this cohort was 3%. Multivariate analysis suggested that driving pressure could be associated with the development of ARDS (odds ratio for unit increment of driving For personal use only. No other uses without permission. Copyright ©2017. Elsevier Inc. All rights reserved. pressure 1.12; confidence interval for 95%: 1.01 to 1.23) whereas we did not observe association for tidal volume (in ml per kg of predicted body weight) or level of PEEP. ARDS was associated with an increase in mortality, longer duration of mechanical ventilation, and longer ICU length of stay. Conclusions: In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.

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“…Ischemic injury to peripheral organs, including kidneys (Liu et al, 2008), lungs (Holland et al, 2003;Rincon et al, 2012), and gut (Zhou et al, 2012), can activate microglia, …”

Section: Discussionmentioning

confidence: 99%

Extracranial Hypothermia During Cardiac Arrest and Cardiopulmonary Resuscitation Is Neuroprotective In Vivo

Hutchens

Fujiyoshi

Koerner

et al. 2014

Therapeutic Hypothermia and Temperature Management

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Impact of Acute Lung Injury and Acute Respiratory Distress Syndrome After Traumatic Brain Injury in the United States

Abstract: Our analysis demonstrates that ARDS/ALI is common after TBI. Despite an overall reduction of in-hospital mortality, ARDS/ALI carries a higher risk of in-hospital death after TBI.

Cited by 120 publications

References 42 publications

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

Extracranial Hypothermia During Cardiac Arrest and Cardiopulmonary Resuscitation Is Neuroprotective In Vivo

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