Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury

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Object. The factors involved in the development of adult respiratory distress syndrome (ARDS) after severe head injury were studied. The presence of ARDS complicates the treatment of patients with severe head injury, both because hypoxia causes additional injury to the brain and because therapies that are used to protect the lungs and improve oxygenation in patients with ARDS can reduce cerebral blood flow (CBF) and increase intracranial pressure (ICP). In a recent randomized trial of two head-injury management strategies (ICP-targeted and CBF-targeted), a fivefold increase in the incidence of ARDS was observed in the CBF-targeted group.

Methods. Injury severity, physiological data, and treatment data in 18 patients in whom ARDS had developed were compared with the remaining 171 patients in the randomized trial in whom it had not developed. Logistic regression analysis was used to study the interaction of the factors that were related to the development of ARDS.

In the final exact logistic regression model, several factors were found to be significantly associated with an increased risk of ARDS: administration of epinephrine (5.7-fold increased risk), administration of dopamine in a larger than median dose (10.8-fold increased risk), and a history of drug abuse (3.1-fold increased risk).

Conclusions. Although this clinical trial was not designed to study the association of management strategy and the occurrence of ARDS, the data strongly indicated that induced hypertension in this high-risk group of patients is associated with the development of symptomatic ARDS.

Article Information

Address reprint requests to: Claudia Robertson, M.D., Department of Neurosurgery, Baylor College of Medicine, 6560 Fannin, Suite 944, Houston, Texas 77030. email: claudiar@bcm.tmc.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Chart demonstrating that the development of ARDS complicates the management of severe head injury. Hypoxia is an important cause of secondary injury to the brain. The management strategies intended to improve oxygenation and to protect the lung from barotrauma, however, can reduce BP, increase ICP, and result in hypercarbia. I:E = inspiration/expiration; NO = nitric oxide; pCO2 = PaCO2.

  • View in gallery

    Bar graph showing that ARDS occurred in patients admitted throughout the 32-month clinical trial, but primarily in the CBF-targeted treatment groups. Each pair of bars represents a different resident physician group.

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