Abstract Details

ARDS causes pulmonary vascular endothelial injury.  CMBs have been previously associated with acute critical illness. However, the association between CMBs in ARDS and acute cerebrovascular pathology is not well studied.

To describe and compare acute cerebrovascular findings on MRI among patients with acute respiratory distress syndrome (ARDS) with cerebral microbleeds (CMBs) to those without CMBs.

We reviewed patient data from an ARDS registry at a tertiary medical center from January 2010 to October 2018. Patients with brain MRIs during their ICU stay were included.  Patients were excluded if MRI imaging was motion degraded or did not include susceptibility weighted imaging (SWI) or T2*weighted gradient echo sequences. CMBs were defined as hypointense SWI or T2* lesions <5 mm. Acute vascular findings on MRI included acute cerebral ischemia, intracerebral hemorrhage (ICH), and  subarachnoid hemorrhage (SAH). Univariate analysis was performed to examine association of acute cerebrovascular pathology with CMBs.

Of 678 patients with ARDS, 61 had brain MRIs and were included in the analyses. CMBs were present in 12 (20%) patients with median age 62.5 years. Six patients had >10 microbleeds. CMBs were associated with presence of acute cerebral ischemia. Five of 12 (43%) patients with CMBs had acute cerebral ischemia and 5 of 49 (10%) patients without CMBs had acute cerebral ischemia, odds ratio (OR) 6.3, 95% confidence interval (CI) 1.4-27. CMBs were not associated with presence of ICH.  One patient with CMBs and 3 patients without CMBs had ICH, (OR 1.4, 95% CI: 0.13-15). One patient with CMBs had a non-aneurysmal subarachnoid hemorrhage in the cortical sulcus.

CMBs are common in patients with ARDS and are often multiple and diffuse in distribution. The association of CMBs with acute cerebral ischemia and non-aneurysmal sulcal SAH may indicate ongoing ischemic and hemorrhagic vascular injury in ARDS.