기계환기 적용 중 발생한 두개강내출혈 환자의 임상적 특성과 예후
Clinical Characteristics and Prognosis of Patients with Intracranial Hemorrhage during Mechanical Ventilation
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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.
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.
참고문헌 (26)
- Pilitsis JG, "Complications of head injury", Neurol Res, 23, pp.227~236 (2001)
- Mohr JP, "The Harvard Cooperative Stroke Registry: a prospective registry", Neurology, 28, pp.754~762 (1978)
- Bamford J, "A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project--1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage", J Neurol Neurosurg Psychiatry, 53, pp.16~22 (1990)
- Junttila EK, "Risk factors for 1-year mortality in patients with nontraumatic intracranial hemorrhage requiring intensive care", Acta Anaesthesiol Scand, 55, pp.1052~1060 (2011)
- Ariesen MJ, "Risk factors for intracerebral hemorrhage in the general population: a systematic review", Stroke, 34, pp.2060~2065 (2003)
- Juvela S, "Risk factors for spontaneous intracerebral hemorrhage", Stroke, 26, pp.1558~1564 (1995)
- Chen HS, "Risk factors of in-hospital mortality of intracerebral hemorrhage and comparison of ICH scores in a Taiwanese population", Eur Neurol, 66, pp.59~63 (2011)
- Gorelick PB, "Risk of hemorrhagic stroke with aspirin use: an update", Stroke, 36, pp.1801~1807 (2005)
- Iso H, "Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial", N Engl J Med, 320, pp.904~910 (1989)
- Kase CS, "Intracerebral hemorrhage: non-hypertensive causes", Stroke, 17, pp.590~595 (1986)
- Ruíz-Sandoval JL, "Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis", Stroke, 30, pp.537~541 (1999)
- Lai CH, "Liver cirrhosis and risk of intracerebral hemorrhage: a 9-year follow-up study", Stroke, 42, pp.2615~2617 (2011)
- Winney RJ, "Changes in brain water with haemodialysis", Lancet, 2, pp.1107~1108 (1986)
- Thompson BB, "Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review", Neurology, 75, pp.1333~1342 (2010)
- Perlman JM, "Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome", N Engl J Med, 312, pp.1353~1357 (1985)
- Perlman JM, "Fluctuating cerebral blood-flow velocity in respiratory-distress syndrome. Relation to the development of intraventricular hemorrhage", N Engl J Med, 309, pp.204~209 (1983)
- Kerr ME, "Effect of endotracheal suctioning on cerebral oxygenation in traumatic brain-injured patients", Crit Care Med, 27, pp.2776~2781 (1999)
- Bilotta F, "Endotracheal lidocaine in preventing endotracheal suctioning-induced changes in cerebral hemodynamics in patients with severe head trauma", Neurocrit Care, 8, pp.241~246 (2008)
- Song JG, "The usage pattern of neuromuscular blocker at intensive care unit", Korean J Crit Care Med, 21, pp.28~36 (2006)
- Kawamura M, "Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis", Am J Kidney Dis, 31, pp.991~996 (1998)
- 이승훈, "Antithrombotic Drug Use, Cerebral Microbleeds, and Intracerebral Hemorrhage A Systematic Review of Published and Unpublished Studies", STROKE, 41, pp.1222~1228 (2010), LIPPINCOTT WILLIAMS & WILKINS
- Ge L, "Aspirin treatment increases the risk of cerebral microbleeds", Can J Neurol Sci, 38, pp.863~868 (2011)
- Antithrombotic Trialists' (ATT) Collaboration, "Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials", Lancet, 373, pp.1849~1860 (2009)
- Cervera A, "Oral anticoagulant-associated intracerebral hemorrhage", J Neurol, 259, pp.212~224 (2012)
- Iribarren C, "Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program", Stroke, 27, pp.1993~1998 (1996)
- Woo J, "Acute and long-term changes in serum lipids after acute stroke", Stroke, 21, pp.1407~1411 (1990)