Non-Neurological Complications of Brain Injury

  • John P. Adams
Part of the Competency-Based Critical Care book series (CBCC)

Key Points

  1. 1.

    Medical complications are now recognized as significant contributors to patient outcome after severe neurological injury

  2. 2.

    Respiratory complications may account for up to 50% of deaths following brain injury

  3. 3.

    Neurogenic pulmonary edema (NPO) requires aggressive management with positive pressure ventilation and careful restoration of the systemic circulating volume

  4. 4.

    Patients with NPO and myocardial stunning often appear moribund, but have a good chance of rapid recovery if appropriately managed

  5. 5.

    Patients with severe cardiac dysfunction after brain injury require invasive cardiovascular monitoring (e.g., pulmonary artery catheter) to accurately guide therapy

  6. 6.

    Cerebral salt wasting is common after subarachnoid hemorrhage (SAH), and must be distinguished from SIADH.



Traumatic Brain Injury Brain Injury Acute Lung Injury Pulmonary Capillary Wedge Pressure Acute Brain Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Arango MF, Andrews PJ (2001) Systemic complications of neurologic diseases. Curr Opin Crit Care 7(2):61–67CrossRefPubMedGoogle Scholar
  2. Asgeirsson B, Grande PO, Nordstrom CH, Berntman L, Messeter K, Ryding E (1995) Effects of hypotensive treatment with alpha 2-agonist and beta 1-antagonist on cerebral haemodynamics in severely head injured patients. Acta Anaesthesiol Scand 39(3):347–351CrossRefPubMedGoogle Scholar
  3. Bernard F, Outtrim J, Menon DK, Matta BF (2006) Incidence of adrenal insufficiency after severe traumatic brain injury varies according to definition used: clinical implications. Br J Anaesth 96(1):72–76CrossRefPubMedGoogle Scholar
  4. Brouwers PJ, Wijdicks EF, Hasan D, Vermeulen M, Wever EF, Frericks H et al (1989) Serial electrocardiographic recording in aneurysmal subarachnoid hemorrhage. Stroke 20(9):1162–1167PubMedGoogle Scholar
  5. Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS (2001) Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg 95(4):560–568CrossRefPubMedGoogle Scholar
  6. Cropp GJ, Manning GW (1960) Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation 22:25–38PubMedGoogle Scholar
  7. Das M, Gonsalves S, Saha A, Ross S, Williams G (2009) Acute subarachnoid hemorrhage as a precipitant for takotsubo cardiomyopathy: A case report and discussion. Int J Cardiol 132(2):283–285Google Scholar
  8. Davidson JT, Charuzi I (1973) Epinephrine-induced changes in the pulmonary pressure-volume curve of the intact and hypovolemic rabbit. Chest 63(2):250–253CrossRefPubMedGoogle Scholar
  9. Deehan SC, Grant IS (1996) Haemodynamic changes in neurogenic pulmonary edema: effect of dobutamine. Intensive Care Med 22(7):672–676CrossRefPubMedGoogle Scholar
  10. Doshi R, Neil-Dwyer G (1980) A clinicopathological study of patients following a subarachnoid hemorrhage. J Neurosurg 52(3):295–301CrossRefPubMedGoogle Scholar
  11. Ewig S, Torres A, El-Ebiary M, Fabregas N, Hernandez C, Gonzalez J et al (1999) Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia. Am J Respir Crit Care Med 159(1):188–198PubMedGoogle Scholar
  12. Friedman JA, Pichelmann MA, Piepgras DG, McIver JI, Toussaint LG, 3rd, McClelland RL, et al (2003) Pulmonary complications of aneurysmal subarachnoid hemorrhage. Neurosurgery 52(5):1025–1031; discussion 31–32.Google Scholar
  13. Frontera JA, Parra A, Shimbo D, Fernandez A, Schmidt JM, Peter P et al (2008) Cardiac arrhythmias after subarachnoid hemorrhage: risk factors and impact on outcome. Cerebrovasc Dis 26(1):71–78CrossRefPubMedGoogle Scholar
  14. Galloon S, Rees GA, Briscoe CE, Davies S, Kilpatrick GS (1972) Prospective study of electrocardiographic changes associated with subarachnoid hemorrhage. Br J Anaesth 44(5):511–516CrossRefPubMedGoogle Scholar
  15. Graf CJ, Rossi NP (1978) Catecholamine response to intracranial hypertension. J Neurosurg 49(6):862–868CrossRefPubMedGoogle Scholar
  16. Gruber A, Reinprecht A, Illievich UM, Fitzgerald R, Dietrich W, Czech T et al (1999) Extracerebral organ dysfunction and neurologic outcome after aneurysmal subarachnoid hemorrhage. Crit Care Med 27(3):505–514CrossRefPubMedGoogle Scholar
  17. Hammermeister KE, Reichenbach DD (1969) QRS changes, pulmonary edema, and myocardial necrosis associated with subarachnoid hemorrhage. Am Heart J 78(1):94–100CrossRefPubMedGoogle Scholar
  18. Horowitz MB, Willet D, Keffer J (1998) The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 140(1):87–93CrossRefGoogle Scholar
  19. Hulka F, Mullins RJ, Frank EH (1996) Blunt brain injury activates the coagulation process. Arch Surg 131(9):923–927; discussion 27–28Google Scholar
  20. Kollef MH, Skubas NJ, Sundt TM (1999) A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest 116(5):1339–1346CrossRefPubMedGoogle Scholar
  21. Macmillan CS, Grant IS, Andrews PJ (2002) Pulmonary and cardiac sequelae of subarachnoid hemorrhage: time for active management? Intensive Care Med 28(8):1012–1023CrossRefPubMedGoogle Scholar
  22. Naidech A, Du Y, Kreiter KT, Parra A, Fitzsimmons BF (2005) Lavine SD, et al. Dobutamine versus milrinone after subarachnoid hemorrhage. Neurosurgery 56(1):21–6l discussion 26–37Google Scholar
  23. Naidech AM, Jovanovic B, Wartenberg KE, Parra A, Ostapkovich N, Connolly ES et al (2007) Higher hemoglobin is associated with improved outcome after subarachnoid hemorrhage. Crit Care Med 35(10):2383–2389CrossRefPubMedGoogle Scholar
  24. Naredi S, Lambert G, Eden E, Zall S, Runnerstam M, Rydenhag B et al (2000) Increased sympathetic nervous activity in patients with nontraumatic subarachnoid hemorrhage. Stroke 31(4):901–906PubMedGoogle Scholar
  25. Neil-Dwyer G, Walter P, Cruickshank JM, Doshi B, O’Gorman P (1978) Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid hemorrhage. Br Med J 2(6143):6990–2CrossRefGoogle Scholar
  26. Owings JT, Gosselin R (1997) Acquired antithrombin deficiency following severe traumatic injury: rationale for study of antithrombin supplementation. Semin Thromb Hemost 23(Suppl 1):17–24CrossRefPubMedGoogle Scholar
  27. Parr MJ, Finfer SR, Morgan MK (1996) Reversible cardiogenic shock complicating subarachnoid hemorrhage. BMJ 313(7058):681–683PubMedGoogle Scholar
  28. Pelosi P, Severgnini P, Chiaranda M (2005) An integrated approach to prevent and treat respiratory failure in brain-injured patients. Curr Opin Crit Care 11(1):37–42CrossRefPubMedGoogle Scholar
  29. Reinprecht A, Greher M, Wolfsberger S, Dietrich W, Illievich UM, Gruber A (2003) Prone position in subarachnoid hemorrhage patients with acute respiratory distress syndrome: effects on cerebral tissue oxygenation and intracranial pressure. Crit Care Med 31(6):1831–1838CrossRefPubMedGoogle Scholar
  30. Rogers FB, Shackford SR, Trevisani GT, Davis JW, Mackersie RC, Hoyt DB (1995) Neurogenic pulmonary edema in fatal and nonfatal head injuries. J Trauma 39(5):860–866; discussion 66–68Google Scholar
  31. Rudehill A, Gordon E, Sundqvist K, Sylven C, Wahlgren NG (1982) A study of ECG abnormalities and myocardial specific enzymes in patients with subarachnoid hemorrhage. Acta Anaesthesiol Scand 26(4):344–350CrossRefPubMedGoogle Scholar
  32. Schumacker PT, Rhodes GR, Newell JC, Dutton RE, Shah DM, Scovill WA et al (1979) Ventilation-perfusion imbalance after head trauma. Am Rev Respir Dis 119(1):33–43PubMedGoogle Scholar
  33. Shorr AF, O’Malley PG (2001) Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia : potential economic implications. Chest 119(1):228–235CrossRefPubMedGoogle Scholar
  34. Shuster S (1960) The electrocardiogram in subarachnoid hemorrhage. Br Heart J 22:316–320CrossRefPubMedGoogle Scholar
  35. Simmons RL, Martin AM, Jr, Heisterkamp CA, 3rd, Ducker TB. (1969)Respiratory insufficiency in combat casualties. II. Pulmonary edema following head injury. Ann Surg 170(1):39–44Google Scholar
  36. Sirvent JM, Torres A, Vidaur L, Armengol J, de Batlle J, Bonet A (2000) Tracheal colonisation within 24 h of intubation in patients with head trauma: risk factor for developing early-onset ventilator-associated pneumonia. Intensive Care Med 26(9):1369–1372CrossRefPubMedGoogle Scholar
  37. Siwadlowski W, Aravanis C, Worthen M, Luisada AA (1970) Mechanism of adrenalin pulmonary edema and its prevention by narcotics and autonomic blockers. Chest 57(6):554–557CrossRefPubMedGoogle Scholar
  38. Smith WS, Matthay MA (1997) Evidence for a hydrostatic mechanism in human neurogenic pulmonary edema. Chest 111(5):1326–1333CrossRefPubMedGoogle Scholar
  39. Solenski NJ, Haley EC Jr, Kassell NF, Kongable G, Germanson T, Truskowski L et al (1995) Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. participants of the multicenter cooperative aneurysm study. Crit Care Med 23(6):1007–1017CrossRefPubMedGoogle Scholar
  40. Szabo MD, Crosby G, Hurford WE, Strauss HW (1993) Myocardial perfusion following acute subarachnoid hemorrhage in patients with an abnormal electrocardiogram. Anesth Analg 76(2):253–258CrossRefPubMedGoogle Scholar
  41. Touho H, Karasawa J, Shishido H, Yamada K, Yamazaki Y (1989) Neurogenic pulmonary edema in the acute stage of hemorrhagic cerebrovascular disease. Neurosurgery 25(5):762–768CrossRefPubMedGoogle Scholar
  42. Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L et al (1995) Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 122(3):179–186PubMedGoogle Scholar
  43. Venkatesh B, Townsend S, Boots RJ (1999) Does splanchnic ischemia occur in isolated neurotrauma? A prospective observational study. Crit Care Med 27(6):1175–1180CrossRefPubMedGoogle Scholar
  44. West JB, Mathieu-Costello O (1992) Stress failure of pulmonary capillaries in the intensive care setting. Schweiz Med Wochenschr 122(20):751–757PubMedGoogle Scholar
  45. Wolf S, Schurer L, Trost HA, Lumenta CB (2002) The safety of the open lung approach in neurosurgical patients. Acta Neurochir Suppl 81:99–101PubMedGoogle Scholar
  46. Yeh CC, Wu CT, Lu CH, Yang CP, Wong CS (2003) Early use of small-dose vasopressin for unstable hemodynamics in an acute brain injury patient refractory to catecholamine treatment: a case report. Anesth Analg 97(2):577–579Google Scholar
  47. York J, Arrillaga A, Graham R, Miller R. (2000) Fluid resuscitation of patients with multiple injuries and severe closed head injury: experience with an aggressive fluid resuscitation strategy. J Trauma 48(3):376–379; discussion 79–80Google Scholar
  48. Zygun DA, Kortbeek JB, Fick GH, Laupland KB, Doig CJ (2005) Non-neurologic organ dysfunction in severe traumatic brain injury. Crit Care Med 33(3):654–660CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2010

Authors and Affiliations

  • John P. Adams
    • 1
  1. 1.Leeds General Infirmary Leeds Teaching Hospitals NHS TrustLeedsUK

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