PURPOSE:To ascertain the incidence of respiratory complications in a neuro-intensive care unit and to compare admission characteristics and short-term outcomes in patients with or without such complications.
METHODS:Retrospective review of all patients admitted to an eight-bed neuro ICU at a tertiary university hospital in 2006. Medical records were reviewed for demographic data (age, sex,operative status, and history of prior respiratory disease), respiratory complications and outcomes.
RESULTS:A total of 689 patients (51.4% male) were identified. Most patients were admitted to the neuro ICU due to spinal disease (32.7%), hemorrhagic CVA (21%), brain tumor (10%), and ischemic CVA (9%); 68.2% of patients were post-operative. Almost a third of patients developed respiratory complications (n=210, 30.5%); the most common were atelectasis (78.1%), pleural effusion (52.4%), mechanical ventilation (35.2%) and pneumonia (32.9%). Patients who developed complications were older than those who did not develop any respiratory complications (69.2 +/- 17.5 vs. 58.0 +/- 17.1, p<0.0001). Those patients with a prior history of COPD were twice as likely to develop complications (59.3% vs. 29.3%, p<0.0021); hemorrhagic CVA and ischemic CVA were also associated with respiratory complications (57.9% vs. 23.2%, p<0.0001 and 49.2% vs. 28.6%, p<0.0001, respectively). There was a trend towards significant association between pulmonary complications and traumatic brain or spine injury (p<0.10). Length of stay (14.6 vs. 6.7 days), transfer to other facilities (38.6% vs. 25.1%) and mortality (25.7% vs. 1.3%) were significantly higher in a patient with respiratory complications (p<0.0001). Respiratory complications were not associated with post-operative status among this sample of patients.
CONCLUSION:Almost 1 in 3 patients treated in the neuro ICU developed respiratory complications and their clinical course was significantly worse than patient without complications. Patients who were older, had a prior medical history of COPD and were being treated for hemorrhagic or ischemic CVA were more likely to develop respiratory complications.
CLINICAL IMPLICATIONS:Patient with hemorrhagic or ischemic CVA have a higher frequency of respiratory complications and efforts are needed to find ways to modify this risk factor.
DISCLOSURE:Navdeep Brar, No Financial Disclosure Information; No Product/Research Disclosure Information