BACKGROUND AND PURPOSE: Intubation and mechanical ventilation are sometimes necessary during treatment of acute stroke. Indications include neurological deterioration, pulmonary complications, and elective intubation for procedures and surgery. Prognosis in severe stroke patients requiring mechanical ventilation has often been reported to be poor. This study was performed to prospectively assess the prognosis of stroke patients who require ventilation in a neurological intensive care unit and to determine factors that may influence outcome. METHODS: Analysis was made of 124 consecutive stroke patients who required mechanical ventilation over a 2-year period. We determined the survival rate at 1 year after admission. Initial clinical data, history of previous diseases, and indication for intubation were analyzed for prognostic significance by univariate and multiple logistic regression analysis. RESULTS: The 1-year survival rate was 33.1% (n = 41). Sixty-five patients (52%) died in the neurological intensive care unit. Among 17 variables analyzed, seven were found to significantly influence 2-month fatality in the univariate analysis: age greater than 65 years, atrial fibrillation, bilateral absence of pupillary light reflex, bilateral absence of corneal reflex, bilateral Babinski's sign, infratentorial stroke, and Glasgow Coma Scale (GCS) score less than 10. Independent predictors of death at 2 months were age greater than 65 years (P = .03), GCS score less than 10 (P = .01), and intubation performed because of coma or acute respiratory failure (P = .04). CONCLUSIONS: Overall prognosis of ventilated patients with severe stroke is better than previously reported. Older patients comatose on admission who need to be intubated because of neurological or respiratory deterioration have the poorest prognosis. We conclude that intubation and mechanical ventilation of severe stroke patients should be performed in a timely manner, before irreversible damage occurs.
BACKGROUND AND PURPOSE: Intubation and mechanical ventilation are sometimes necessary during treatment of acute stroke. Indications include neurological deterioration, pulmonary complications, and elective intubation for procedures and surgery. Prognosis in severe strokepatients requiring mechanical ventilation has often been reported to be poor. This study was performed to prospectively assess the prognosis of strokepatients who require ventilation in a neurological intensive care unit and to determine factors that may influence outcome. METHODS: Analysis was made of 124 consecutive strokepatients who required mechanical ventilation over a 2-year period. We determined the survival rate at 1 year after admission. Initial clinical data, history of previous diseases, and indication for intubation were analyzed for prognostic significance by univariate and multiple logistic regression analysis. RESULTS: The 1-year survival rate was 33.1% (n = 41). Sixty-five patients (52%) died in the neurological intensive care unit. Among 17 variables analyzed, seven were found to significantly influence 2-month fatality in the univariate analysis: age greater than 65 years, atrial fibrillation, bilateral absence of pupillary light reflex, bilateral absence of corneal reflex, bilateral Babinski's sign, infratentorial stroke, and Glasgow Coma Scale (GCS) score less than 10. Independent predictors of death at 2 months were age greater than 65 years (P = .03), GCS score less than 10 (P = .01), and intubation performed because of coma or acute respiratory failure (P = .04). CONCLUSIONS: Overall prognosis of ventilated patients with severe stroke is better than previously reported. Older patientscomatose on admission who need to be intubated because of neurological or respiratory deterioration have the poorest prognosis. We conclude that intubation and mechanical ventilation of severe strokepatients should be performed in a timely manner, before irreversible damage occurs.
Authors: Shouri Lahiri; Babak B Navi; Stephan A Mayer; Axel Rosengart; Alexander E Merkler; Jan Claassen; Hooman Kamel Journal: Stroke Date: 2015-08-13 Impact factor: 7.914
Authors: Brian P Walcott; Jennifer C Miller; Churl-Su Kwon; Sameer A Sheth; Marc Hiller; Carolyn A Cronin; Lee H Schwamm; J Marc Simard; Kristopher T Kahle; W Taylor Kimberly; Kevin N Sheth Journal: Neurocrit Care Date: 2014-08 Impact factor: 3.210
Authors: Michel T Torbey; Julian Bösel; Denise H Rhoney; Fred Rincon; Dimitre Staykov; Arun P Amar; Panayiotis N Varelas; Eric Jüttler; DaiWai Olson; Hagen B Huttner; Klaus Zweckberger; Kevin N Sheth; Christian Dohmen; Ansgar M Brambrink; Stephan A Mayer; Osama O Zaidat; Werner Hacke; Stefan Schwab Journal: Neurocrit Care Date: 2015-02 Impact factor: 3.210
Authors: Kevin N Sheth; W Taylor Kimberly; Jordan J Elm; Thomas A Kent; Albert J Yoo; Götz Thomalla; Bruce Campbell; Geoffrey A Donnan; Stephen M Davis; Gregory W Albers; Sven Jacobson; Gregory del Zoppo; J Marc Simard; Barney J Stern; Pitchaiah Mandava Journal: Neurocrit Care Date: 2014-08 Impact factor: 3.210
Authors: Eva Schielke; Markus A Busch; Thomas Hildenhagen; Martin Holtkamp; Ingeborg Küchler; Lutz Harms; Florian Masuhr Journal: J Neurol Date: 2005-03-07 Impact factor: 4.849