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Korean J Crit Care Med > Volume 27(2); 2012 > Article
Korean Journal of Critical Care Medicine 2012;27(2): 94-101. doi: https://doi.org/10.4266/kjccm.2012.27.2.94
기계환기 적용 중 발생한 두개강내출혈 환자의 임상적 특성과 예후
Go Woon Kim, M.D., Jin Won Huh, M.D., Younsuck Koh, M.D., Chae Man Lim, M.D. and Sang Bum Hong, M.D.
Clinical Characteristics and Prognosis of Patients with Intracranial Hemorrhage during Mechanical Ventilation
Go Woon Kim, Jin Won Huh, Younsuck Koh, Chae Man Lim, Sang Bum Hong
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jwhuh@amc.seoul.kr
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.
Key Words: cerebral hemorrhage; intensive care unit; intracranial hemorrhage; mechanical; ventilators; ventilator weaning
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