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Am J Crit Care. 2019 Nov;28(6):477-480. doi: 10.4037/ajcc2019310.

Long-term Outcomes of Critically Ill Patients With Stroke Requiring Mechanical Ventilation.

Author information

1
Perrine Bouvet is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France, and Department of Anesthesiology, Montelimar Hospital, Montelimar, France. Martin Murgier is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital. Bertrand Pons is a physician, medical-surgical intensive care unit, Pointe à Pitre University Hospital, Guadeloupe, France. Michael Darmon is a physician, medical intensive care unit, Saint-Louis University Hospital, AP-HP, Paris, France; a professor of intensive care medicine, Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France; and a researcher on the ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.
2
Perrine Bouvet is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France, and Department of Anesthesiology, Montelimar Hospital, Montelimar, France. Martin Murgier is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital. Bertrand Pons is a physician, medical-surgical intensive care unit, Pointe à Pitre University Hospital, Guadeloupe, France. Michael Darmon is a physician, medical intensive care unit, Saint-Louis University Hospital, AP-HP, Paris, France; a professor of intensive care medicine, Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France; and a researcher on the ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France. michael.darmon@aphp.fr.

Abstract

BACKGROUND:

Data on outcomes of critically ill patients requiring mechanical ventilation at the onset of stroke are limited.

OBJECTIVE:

To assess the hospital and long-term functional outcomes of patients with stroke who require mechanical ventilation.

METHODS:

This retrospective single-center cohort study performed from 1994 to 2008 involved adult patients within 7 days of stroke onset and who required intensive care unit admission and mechanical ventilation.

RESULTS:

A total of 274 patients requiring mechanical ventilation at the onset of stroke were analyzed. Indications for intubation included coma in 195 patients (71%). The median (interquartile range) score on the Glasgow Coma Scale at admission to the intensive care unit was 6 (3-9). Forty-four patients (16%) had sepsis at intensive care unit admission. The overall hospital mortality rate was 53%. After adjustment for confounders, severity of illness at admission as assessed by the Simplified Acute Physiology Score II (odds ratio, 1.07; 95% CI, 1.05-1.10), anisocoria (odds ratio, 5.26; 95% CI, 1.76-15.80), and sepsis at intensive care unit admission (odds ratio, 0.40; 95% CI, 0.19-0.85) were associated with outcome. At 1 year, median (interquartile range) modified Rankin Scale score was 6 (2-6). Only 89 patients (32%) exhibited mild to moderate neurologic impairment.

CONCLUSION:

In this study, adult patients requiring mechanical ventilation at the onset of stroke experienced high 1-year mortality, with survivors having poor functional status.

PMID:
31676523
DOI:
10.4037/ajcc2019310

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