Abstract TP138: Prevalence And Risk Factors Associated With Cerebral Microbleeds In Patients With Acute Respiratory Distress Syndrome

Introduction: Acute respiratory distress syndrome (ARDS) is associated with pulmonary vascular endothelial injury. Cerebral microbleeds (CMB) have been reported in patients with critical illness such as ARDS, particularly involving the splenium of the corpus callosum and immediate subcortical white matter. We aimed to examine the prevalence and risk factors of CMB in ARDS. Methods: We reviewed patient data from an ARDS registry at a tertiary medical center from January 2010 to October 2018. Patients were excluded if MRI imaging was motion degraded or did not include susceptibility weighted imaging (SWI) or T2*weighted gradient echo sequences. CMB were defined as hypointense SWI or T2* lesions <5 mm. Microbleeds were labeled as diffuse if there were ≥10 present in a region. ARDS rescue therapies included extracorporeal membrane oxygenation, inhaled vasodilators, recruitment maneuvers, high frequency oscillatory ventilation, neuromuscular blockade, and proning. Univariate analysis was performed to examine association with CMB. Results: Of the 678 patients with ARDS, 61 had MRI’s meeting inclusion criteria. CMB were present in 12 patients, with median age 62.5 years. Ten patients had lobar CMB, of which 4 were diffuse and also involved the cerebellum. There were 3 patients with CMB in the corpus callosum, all involving the splenium, of which 2 were diffuse among patients who had diffuse lobar involvement. Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment scores did not differ between those with and without CMB, but ARDS rescue therapies were more commonly used in patients with CMB (66.7% vs 22.4%, p=.003). CMB was associated with acute cerebral ischemia on MRI (41.7% with CMB vs 10.2% without CMB, p=.008). Conclusions: CMB are common in ARDS, mostly involving the cerebral lobes and cerebellum. CMB might be associated with ARDS rescue therapies and higher risk for ischemic infarcts.