Korean J Crit Care Med.  2012 May;27(2):94-101. 10.4266/kjccm.2012.27.2.94.

Clinical Characteristics and Prognosis of Patients with Intracranial Hemorrhage during Mechanical Ventilation

• Kim GW
• Huh JW
• Koh Y
• Lim CM
• Hong SB

• KMID: 2227999
• DOI: http://doi.org/10.4266/kjccm.2012.27.2.94

Abstract

BACKGROUND
Intracranial hemorrhage is a serious disease associated with high mortality and morbidity, and develops suddenly without warning. Although there were known risk factors, it is difficult to prevent brain hemorrhage from critically ill patients in the intensive care unit (ICU). There are several reports that brain hemorrhage, in critically ill patients, occurred in connection with respiratory diseases. The aim of our study is to describe the baseline characteristics and prognosis of patients with intracranial hemorrhage during mechanical ventilation in the ICU.
METHODS
We retrospectively reviewed the medical records of 56 patients, who developed intracranial hemorrhage in a medical ICU, from May 2008 to December 2011. During the mechanical ventilation in the ICU, patients were implemented with a weaning process, following ACCP (American College of Chest Physicians) criteria. Also, we compared patients with brain hemorrhage to those without brain hemorrhage.
RESULTS
Thirty two of the 56 patients (57.1%) were male, and median ages were 63 (17-90) years. The common type of brain hemorrhage confirmed was intracerebral hemorrhage/intraventricular hemorrhage (52.2%). The duration from mechanical ventilation to brain hemorrhage was 6 (0-58) days. Overall hospital mortality was 57.1%, and ICU mortality was 44.6%. The most common cause of death was brain hemorrhage (40.6%). In comparison to patients without brain hemorrhage, study patients showed less use of anticoagulants and lower ventilator pressure. Our study showed that the use of vasopressor, systolic blood pressure, peak airway pressure, and platelet count were associated with brain hemorrhage.
CONCLUSIONS
Intracranial hemorrhage showed high mortality in critically ill patients with mechanical ventilation. In the future, large case-control study will be needed to evaluate the risk factors of cerebral hemorrhage.

Keyword

cerebral hemorrhage; intensive care unit; intracranial hemorrhage; mechanical; ventilators; ventilator weaning

MeSH Terms

Anticoagulants
Blood Pressure
Brain
Case-Control Studies
Cause of Death
Cerebral Hemorrhage
Critical Illness
Hemorrhage
Hospital Mortality
Humans
Intensive Care Units
Intracranial Hemorrhages
Male
Medical Records
Platelet Count
Prognosis
Respiration, Artificial
Retrospective Studies
Risk Factors
Thorax
Ventilator Weaning
Ventilators, Mechanical
Weaning
Anticoagulants