High Prevalence of Acute Brain Injury on Brain Magnetic Resonance Imaging in Acute Respiratory Distress Syndrome

Abstract

Abstract Objective: Acute Respiratory Distress Syndrome(ARDS) is an acute inflammatory respiratory failure condition that may be associated with acute brain injury (ABI). We aimed to describe the prevalence and types of ABI detected by brain MRI among ARDS patients. Methods: We retrospectively reviewed and collected data on ABI as detected by brain MRI during index hospitalization of all ARDS patients at a single tertiary center in the United States from January 2010 to October 2018. ABIs were classified as cerebral ischemia (ischemic infarct and hypoxic ischemic brain injury) or cerebral hemorrhage (intraparenchymal hemorrhage, cerebral microbleeds, subarachnoid hemorrhage, and subdural hematoma). Descriptive statistics were conducted. Results: Of the 678 ARDS patients, 66 (9.7%) underwent brain MRI during their ARDS illness. The most common indication for brain MRI was encephalopathy (45.4%) and the median time from hospital admission to MRI was 10 days (interquartile range 4-17). Of 66, 29 (44%) had MRI evidence of ABI including cerebral ischemia in 33% (22/66) and cerebral hemorrhage in 21% (14/66). Among those with cerebral ischemia, common findings were bilateral globus pallidus infarcts (n=7, 32%), multifocal infarcts (n=5, 23%), and diffuse hypoxic ischemic brain injury (n=3, 14%). Of those with cerebral hemorrhage, common findings were cerebral microbleeds (n=12, 86%) and intraparenchymal hemorrhage (n=2, 14%). ARDS patients with cerebral hemorrhage had significantly greater use of rescue therapies including prone positioning (28.6% vs 5.8%, p = 0.03), inhaled vasodilator (35.7% vs 11.5%, p = 0.046), and recruitment maneuver (14.3% vs 0%, p = 0.04). Conclusion: Among selected patients with ARDS who underwent brain MRI, almost a half had ABI most commonly including bilateral globus pallidus infarcts and cerebral microbleeds.