PULMONARY-FUNCTION AND RADIOGRAPHIC ABNORMALITIES RELATED TO NEUROLOGICAL OUTCOME AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Object. This observational study is based on a consecutive series of 2 07 patients with aneurysmal subarachnoid hemorrhage who were treated w ithin 7 days of their most recent bleed. The purpose of the study was to evaluate the effect of respiratory failure on neurological outcome. Methods. Pulmonary function was assessed by determination of paramete rs describing pulmonary oxygen transport and exchange, by using compos ite scores for quantification of lung injury (lung injury score [LIS]) and mechanical ventilator settings (PIF score). Pulmonary function wa s related to the Hunt and Hess (H & H) grade assigned to the patient a t hospital admission (p < 0.001). The pattern and time course of lung injury differed significantly between patients with H & H Grade I or I I, Grade III, and Grade IV or V. Hunt and Hess grade, Fisher computeri zed tomography grade, intracranial pressure. cerebral perfusion pressu re. LIS, ratio of PaO2 to the fraction of inspired oxygen (FiO(2)), an d the ratio of the alveolar-minus-arterial oxygen tension difference ( AaDO(2)) to FiO(2) were related to neurological outcome (p < 0.001). T he LIS on the day of maximum lung injury remained an independent predi ctor of outcome (p = 0.01) in a stepwise logistic regression analysis. The probability of poor neurological outcome significantly increased with both decreasing cerebral perfusion pressure and increasing severi ty of lung injury, Conclusions. The overall mortality rate was 22.2% ( 46 of 207 patients). Subarachnoid hemorrhage and its neurological sequ elae accounted for the principal mortality in this series, Medical (no nneurological and nontreatment-related) complications accounted for 37 % of all deaths. Systemic inflammatory response syndrome with associat ed multiple organ dysfunction syndrome was the leading cause of death from medical complications. The authors conclude that respiratory fail ure is related to neurological outcome, although it is not commonly th e primary cause of death from medical complications.