Analyses of Lung Parenchyma Infiltrates Using Ultrasonography in Neurocritically ill Patients

Abstract

Purpose

To evaluate the presence of pulmonary infiltrates on admission among patients with intracranial hemorrhages, further refining on etiology and the agreement between ultrasonography and chest radiography.

Materials and Methods

Prospective analysis of patients with aneurysmal subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), during a 3-month period in a single center, utilizing a standardized protocol of lung ultrasonography. Clinical and ancillary testing data were also collected.

Results

44 patients were studied, 30 (68.18%) with ICH, and 14 (31.81%) with SAH. Among patients with ICH, 73.3% had B-lines detected in the assessment, and in the SAH group, 57.14% had presence of lung B-lines. Etiologically, 43% of patients with ICH and 7.1% with SAH had findings suggestive of neurogenic pulmonary edema. 13% of ICH patients and 28.5% in the SAH group had assessments consistent with cardiogenic pulmonary edema. Findings between chest radiography and lung ultrasonography showed poor agreement.

Conclusion

Sonographic lung infiltrates in patients with severe brain injuries are common, reaching up to two-thirds of ICH admissions and the majority of SAH cases. The etiology varied, with presumed neurogenic pulmonary edema leading the incidence in the ICH cohort, and with cardiogenic pulmonary edema being the most common culprit within SAH patients.