Prevalence, early predictors, and outcomes of ARDS in the neuro-ICU: a prospective cohort study

Abstract Background Neurocritically ill patients are at high risk of developing acute respiratory distress syndrome (ARDS), but related studies are still scarce. We aimed to investigate the prevalence, early predictors, and clinical outcomes of ARDS in in the neurological intensive care unit (NICU). Methods This prospective study included consecutive patients in the NICU. The incidence of ARDS was examined, and baseline characteristics were investigated as potential early predictors for ARDS. The in-hospital mortality, length of NICU stay, total cost in NICU, and neurological functions at 90 days were explored. Results Of 165 NICU patients included, 41 (24.8%) developed ARDS (29 [71%] were moderate to severe ARDS). 88% of ARDS cases occurred within one week of admission. NUTRIC score (RR 1.246 95% CI 1.003–1.550, p = 0.047) and PaO2/FiO2 (RR 0.985, 95% CI 0.979–0.992, p < 0.001) on admission were independent associated with ARDS, and high BNP (RR 0.995, 95% CI 0.992–0.998, p = 0.001) was a red flag biomarker warning that the respiratory symptoms may be caused by cardiac failure rather than ARDS. ARDS patients had longer stay (13.8 ± 8.2 vs 10.8 ± 7.3 days, P = 0.029) and higher expenses (51001 ± 29787 vs 34811 ± 29897 Chinese YUAN, P = 0.003) in NICU, compared to non-ARDS patients. None of the NICU patients with moderate to severe ARDS had a favorable outcome at 90 days. Conclusions ARDS is common in NICU, with most cases occurring in the first week of admission. NUTRIC score and PaO2/FiO2 on admission are early predictors of ARDS. ARDS worsens both short-term and long-term outcomes.