Department of Anesthesiology and Intensive Care, Oulu University Hospital, PO Box 21, FIN-90029 OUH, Oulu, Finland.
Anesth Analg. 2013 Apr;116(4):855-61. doi: 10.1213/ANE.0b013e3182811cc7. Epub 2013 Feb 21.
Neurogenic pulmonary edema (NPE) is a well-recognized phenomenon after intracranial insult. In this study, we evaluated the predictors for NPE and its association with outcome in patients with intensive care unit-treated nontraumatic intracranial hemorrhage.
This was a prospective, observational clinical study in a university-level intensive care unit. Clinical characteristics, level of consciousness, and Acute Physiology and Chronic Health Evaluation (APACHE) II score were recorded on admission and the findings of primary head computed tomography were reviewed. A chest radiograph and arterial blood gas analysis were taken serially and NPE was determined as acute bilateral infiltrates in chest radiograph and hypoxemia. Echocardiography and cardiac and inflammatory markers were recorded. The 1-year outcome was assessed using the Glasgow Outcome Scale.
NPE developed in 38 (35%) of the 108 patients included. Predictors for NPE were higher APACHE II score (≥20, odds ratio 6.17, P = 0.003) and higher interleukin-6 plasma concentration (>40 pg/mL, odds ratio 5.62, P = 0.003). Of patients with 0, 1, or 2 predictors mentioned above, 4%, 37%, and 65% had NPE, respectively. NPE was associated with a higher 1-year mortality (37% vs 14%, P = 0.007, respectively), but with an unchanged functional outcome after 1 year (Glasgow Outcome Scale score 1-3, 53% vs 51%, P > 0.9).
Predictors for NPE are the severity of disease defined by APACHE II scores and higher levels of systemic inflammatory mediators. NPE is associated with a higher 1-year mortality, but not with a poorer 1-year functional outcome.
神经源性肺水肿（NPE）是颅内损伤后一种公认的现象。在本研究中，我们评估了重症监护病房治疗的非创伤性颅内出血患者发生 NPE 的预测因素及其与结局的关系。
这是一项在大学水平的重症监护病房进行的前瞻性观察性临床研究。入院时记录临床特征、意识水平和急性生理学和慢性健康评估（APACHE）Ⅱ评分，并回顾原发性头颅 CT 检查结果。连续拍摄胸片和动脉血气分析，并将 NPE 确定为胸片上急性双侧浸润和低氧血症。记录超声心动图和心脏及炎症标志物。使用格拉斯哥结局量表评估 1 年结局。
在纳入的 108 例患者中，38 例（35%）发生 NPE。NPE 的预测因素包括更高的 APACHE Ⅱ评分（≥20，优势比 6.17，P=0.003）和更高的白细胞介素-6 血浆浓度（>40 pg/mL，优势比 5.62，P=0.003）。上述预测因素中 0、1、2 个的患者中，分别有 4%、37%和 65%发生 NPE。NPE 与 1 年死亡率更高相关（37%比 14%，P=0.007），但 1 年后功能结局无变化（格拉斯哥结局量表评分 1-3，53%比 51%，P>0.9）。
NPE 的预测因素是由 APACHE Ⅱ评分定义的疾病严重程度和更高水平的系统性炎症介质。NPE 与 1 年死亡率更高相关，但与 1 年功能结局较差无关。
