• Aurélien Mazeraud, Chiara Robba, Paola Rebora, Carolina Iaquaniello, Alessia Vargiolu, Verena Rass, Elisa Gouvea Bogossian, Raimund Helbok, Fabio Silvio Taccone, and Giuseppe Citerio.
• Neurointensive Care Unit, GHU Paris - Psychiatrie et neurosciences, rue Cabanis 1, 75014, Paris, France.
• Neurocrit Care. 2021 Jun 1; 34 (3): 1000-1008.

BackgroundRespiratory complications are frequently reported after aneurismal subarachnoid hemorrhage (aSAH), even if their association with outcome remains controversial. Acute respiratory distress syndrome (ARDS) is one of the most severe pulmonary complications after aSAH, with a reported incidence ranging from 11 to 50%. This study aims to assess in a large cohort of aSAH patients, during the first week after an intensive care unit (ICU) admission, the incidence of ARDS defined according to the Berlin criteria and its effect on outcome.MethodsThis is a multicentric, retrospective cohort study in 3 European intensive care units. We collected data between January 2009 and December 2017. We included adult patients (≥ 18 years) with a diagnosis of aSAH admitted to the ICU.ResultsA total of 855 patients fulfilled the inclusion criteria. ARDS was assessable in 851 patients. The cumulative incidence of ARDS was 2.2% on the first day since ICU admission, 3.2% on day three, and 3.6% on day seven. At the univariate analysis, ARDS was associated with a poor outcome (p = 0.005) at ICU discharge, and at the multivariable analysis, patients with ARDS showed a worse neurological outcome (Odds ratio = 3.00, 95% confidence interval 1.16-7.72; p = 0.023).ConclusionsARDS has a low incidence in the first 7 days of ICU stay after aSAH, but it is associated with worse outcome.

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