Background and Goal of Study: Aneurysm subarachnoid hemorrhage (ASH) could be
complicated with neurogenic pulmonary edema (NPE). For years, a poor grade ASH was
considered as the main factor for the occurrence of NPE. However,the location of aneurysm
(posterior circulation) has been proposed as predictive of NPE with no role for patient factors or
clinical features of ASH (2). Objectives were to determine 1/ predictive factors for the occurrence of
early NPE in patients with ASH, 2/ outcomes of patients with or without NPE in intensive care unit
(ICU).
Materials and methods: We analyzed records of patients who were admitted (Day0) at University
Hospital for ASH during a 5 years period. Diagnostic of NPE was set up by clinical and preclinical
criteria. Data collected were: demographic, medical history, clinical features of SH, aneurysm
characteristics, ICU parameters at Day 2 and Day 7, and ICU outcomes. A multivariable logistic
regression model included all independent variables with P < 0.25 in the univariate analysis.
Results and discussion: Cases files of 193 patients were analyzed; NPE observed in 17 patients.
On stepwise logistic regression, sex, hypertension, vascular pathology, WFNS grade, aneurysm
location (grouped as anterior or posterior; posterior location defined as any aneurysm of the
vertebral or basilar segment) were found to be relevant factors. On multivariate logistic regression
modeling, the occurrence of PNE, sex, hypertension, vascular pathology, aneurysm location were
found to be independent predictors . Comparing the two groups of patients with or without NPE, we
did not observe any statistical differences in terms of mortality, length of stay and neurological
status at discharge from ICU. In addition, no statistical differences were observed as regards to
sodium level, or presence of vasospasm.
Conclusion(s): In our series of patients, an incidence of clinical PNE of 8.8 % was observed. For
patients with ruptured aneurysm, both patient specified factors (female, vascular pathology) and
aneurysm specified factors (posterior location, particularly with bad neurological status) need to be
carefully considered as high risk factors of developing NPE.

Predictors and ICU outcomes of neurogenic pulmonary edema in aneurysmal subarachnoid hemorrhage