Prognosis of Stroke Patients Requiring Mechanical Ventilation in a Neurological Critical Care Unit
Iraqi Postgraduate Medical Journal,
2017, Volume 16, Issue 3, Pages 274-284
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.
This study was performed at neurosciences hospital for the period 2013 - 2014 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.
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.
The 1-year survival rate was 33.1%. 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, GCS score less than 10, and intubation performed because of coma or acute respiratory failure.
Intubation and mechanical ventilation of severe stroke patients should be performed in a timely manner.older patients comatose on admission requiring mechanical ventilation have very poor prognosis. Fatality rate in our patients was high, but one third were still alive at 1 year after admission. Patients electively intubated in our study had a better prognosis independent from other factors, including age and GCS score.The probability of death at 2 months was more than 2.5 times greater in patients who were intubated because of neurological or respiratory deterioration than in those electively intubated for angiography or surgical intervention.
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