Pulmonary Complications

Pulmonary complications are the commonest medical complication, seen in 15% of SAH patients, and are responsible for half the deaths due to medical complications [9].

Pulmonary edema may be of cardiogenic or neurogenic origin. Neurogenic pulmonary edema consists of an irregular respiratory pattern, with pink frothy airway secretions high in protein content. It is seen in 2-6% of individuals, especially those in coma, and in 13% of cases of fatal SAH [9]. It is caused by disruption of the pulmonary capillary endothelium and increased pulmonary vascular permeability, thought to be caused by SAH-induced vasoconstriction, with a resultant shift of intravascular fluid from the systemic to pulmonary circulation. Cardiogenic pulmonary edema may result from SAH-induced cardiac failure, iatrogeni-cally from fluid treatment for spasm (seen in up to 35% patients treated with "triple H" therapy for spasm) or myocardial infarction secondary to hypertensive therapy.

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