A. Oppenheim-eden et al., Spontaneous intracerebral hemorrhage in critically ill patients: incidenceover six years and associated factors, INTEN CAR M, 25(1), 1999, pp. 63-67
Objective: Intracerebral hemorrhage (ICH) is associated with a high mortali
ty. The present study sought to determine the incidence of spontaneous ICH
in an intensive care unit (ICU) and associated factors.
Design: A 6 year retrospective study.
Setting: A general ICU in a university hospital.
Patients: All ICU patients developing ICH were included in the study. All t
rauma and neurosurgical patients were excluded, as well as patients who wer
e admitted to the ICU because of ICH.
Measurements and results: During the study period 3032 patients were hospit
alized in the ICU, and 834 were excluded. The remaining 2198 patients compr
ised the study population. Computed tomography of the head was performed in
a total of 227 patients, and the 9 patients found to have new onset ICH co
mprise the group of interest. None of these patients were hypertensive. Sev
en of the patients had either a primary hematologic malignancy or bone marr
ow transplantation. Eight had thrombocytopenia of < 100 x 10(9)/1 (median 1
0 x 10(9)/1, range 3-150 x 10(9)/1), and in 6 it preceded ICH by 5 days or
more. Only in one patient were both PTT and PT prolonged. All were mechanic
ally ventilated with high peak inspiratory pressure (PIP) (median 37 cmH(2)
O, range 20-43 cmH(2)O). Arterial carbon dioxide tension (PaCO2) was consid
erably elevated (median 65 mmHg, range 41-87 mmHg). All of the patients had
impaired renal and hepatic function (urea: median 14 mmol/l, range 9.9-52
mmol/l; bilirubin: median 94 mu mol/l, range 20-360 mu mol/l), and five had
septicemia. Eight of the patients bled to other sites before they develope
d ICH. All patients died shortly after the diagnosis of ICH.
Conclusions: Spontaneous nonhypertensive ICH is a rare, fatal event in the
ICU. Associated factors include thrombocytopenia, the need for mechanical v
entilation, elevated PIP and PaCO2, sepsis, and impaired hepatic and renal
function.