Etienne de Montmollin1, Stephane Ruckly2, Carole Schwebel3, Francois Philippart4, Christophe Adrie5, Eric Mariotte6, Guillaume Marcotte7, Yves Cohen8, Benjamin Sztrymf9, Daniel da Silva10, Fabrice Bruneel11, Marc Gainnier12, Maité Garrouste-Orgeas13, Romain Sonneville14, Jean-François Timsit15. 1. UMR 1137, IAME, Paris Diderot University, Sorbonne Paris Cité, 16 rue Henri Huchard, 75018 Paris, France; Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France. Electronic address: etienne.demontmollin@aphp.fr. 2. UMR 1137, IAME, Paris Diderot University, Sorbonne Paris Cité, 16 rue Henri Huchard, 75018 Paris, France. 3. Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, Avenue Maquis du Grésivaudan, 38700 La Tronche, France. 4. Intensive Care Unit, Saint Joseph Hospital Network, 185 Rue Raymond Losserand, 75014 Paris, France; UMR 9891, CNRS-CEA-Paris Saclay university, 1 Avenue De La Terrasse, 91190 Gif-sur-Yvette, France. 5. Physiology department, AP-HP, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France. 6. Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France. 7. Surgical Intensive Care Unit, Lyon University Hospital, 5 Place d'Arsonval, 69003 Lyon, France. 8. Intensive Care Unit, AP-HP, Avicenne Hospital, Paris 13 University, 125 Rue de Stalingrad, 93000 Bobigny, France. 9. Intensive Care Unit, AP-HP, Antoine Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140 Clamart, France. 10. Intensive Care Unit, Delafontaine Hospital, 2 Rue du Dr Delafontaine, 93200 Saint-Denis, France. 11. Intensive Care Unit, André Mignot Hospital, 177 Rue de Versailles, 78150 Le Chesnay, France. 12. Intensive Care Unit, AP-HM, La Timone Hospital, Aix-Marseille University, 278 Rue Saint-Pierre, 13005 Marseille, France. 13. UMR 1137, IAME, Paris Diderot University, Sorbonne Paris Cité, 16 rue Henri Huchard, 75018 Paris, France; Medical Unit, French British Hospital, 4 rue Kléber, 92300 Levallois-Perret, France. 14. Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France; UMR 1148, LVTS, Paris Diderot University, Sorbonne Paris Cité, 46 rue Henri Huchard, 75018 Paris, France. 15. UMR 1137, IAME, Paris Diderot University, Sorbonne Paris Cité, 16 rue Henri Huchard, 75018 Paris, France; Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France.
Abstract
OBJECTIVES: To describe the epidemiology and prognostic impact of pneumonia in acute ischemic stroke patients requiring invasive mechanical ventilation. METHODS: Retrospective analysis from a prospective multicenter cohort study of critically ill patients with acute ischemic stroke requiring invasive mechanical ventilation at admission. Impact of pneumonia was investigated using Cox regression for 1-year mortality, and competing risk survival models for ICU mortality censored at 30-days. RESULTS: We included 195 patients. Stroke was supratentorial in 62% and 64% of patients had a Glasgow coma scale score <8 on admission. Mortality at day-30 and 1 year were 56%, and 70%, respectively. Post-stroke pneumonia was identified in 78 (40%) patients, of which 46/78 (59%) episodes were present at ICU admission. Post-stroke pneumonia was associated with an increase in 1-year mortality (adjusted HR 1.49, 95%CI [1.01-2.20]). Post-stroke pneumonia was not associated with ICU mortality but was associated with a 1.6-fold increase in ICU length of stay (CSHR 0.62 [0.39-0.99], p = 0.06). CONCLUSIONS: In ischemic stroke patients requiring invasive ventilation, pneumonia occurred in 40% of cases and was associated with a 49% increase in 1-year mortality. Post-stroke pneumonia did not impact day-30 mortality but increased ICU length of stay.
OBJECTIVES: To describe the epidemiology and prognostic impact of pneumonia in acute ischemic strokepatients requiring invasive mechanical ventilation. METHODS: Retrospective analysis from a prospective multicenter cohort study of critically illpatients with acute ischemic stroke requiring invasive mechanical ventilation at admission. Impact of pneumonia was investigated using Cox regression for 1-year mortality, and competing risk survival models for ICU mortality censored at 30-days. RESULTS: We included 195 patients. Stroke was supratentorial in 62% and 64% of patients had a Glasgow coma scale score <8 on admission. Mortality at day-30 and 1 year were 56%, and 70%, respectively. Post-stroke pneumonia was identified in 78 (40%) patients, of which 46/78 (59%) episodes were present at ICU admission. Post-stroke pneumonia was associated with an increase in 1-year mortality (adjusted HR 1.49, 95%CI [1.01-2.20]). Post-stroke pneumonia was not associated with ICU mortality but was associated with a 1.6-fold increase in ICU length of stay (CSHR 0.62 [0.39-0.99], p = 0.06). CONCLUSIONS: In ischemic strokepatients requiring invasive ventilation, pneumonia occurred in 40% of cases and was associated with a 49% increase in 1-year mortality. Post-stroke pneumonia did not impact day-30 mortality but increased ICU length of stay.
Authors: R Sonneville; M Mazighi; D Bresson; I Crassard; S Crozier; E de Montmollin; V Degos; F Faugeras; E Gayat; L Josse; C Lamy; E Magalhaes; A Maldjian; S Ruckly; J Servan; P Vassel; B Vigué; J-F Timsit; F Woimant Journal: Neurocrit Care Date: 2020-04 Impact factor: 3.210