One-year survival in acute stroke patients requiring mechanical ventilation: a multicenter cohort study.
Endotracheal intubation
Intensive care
Intracranial hemorrhage
Ischemic stroke
Mechanical ventilation
Subarachnoid hemorrhage
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
07 May 2020
07 May 2020
Historique:
received:
21
01
2020
accepted:
26
04
2020
entrez:
9
5
2020
pubmed:
10
5
2020
medline:
10
5
2020
Statut:
epublish
Résumé
Most prognostic studies in acute stroke patients requiring invasive mechanical ventilation are outdated and have limitations such as single-center retrospective designs. We aimed to study the association of ICU admission factors, including the reason for intubation, with 1-year survival of acute stroke patients requiring mechanical ventilation. We conducted a secondary data use analysis of a prospective multicenter database (14 ICUs) between 1997 and 2016 on consecutive ICU stroke patients requiring mechanical ventilation at admission. We excluded patients with stroke of traumatic origin, subdural hematoma or cerebral venous thrombosis. The primary outcome was survival 1 year after ICU admission. Factors associated with the primary outcome were identified using a multivariable Cox model stratified on inclusion center. We identified 419 patients (age 68 [58-76] years, males 60%) with a Glasgow coma score (GCS) of 4 [3-8] at admission. Stroke subtypes were acute ischemic stroke (AIS, 46%), intracranial hemorrhage (ICH, 42%) and subarachnoid hemorrhage (SAH, 12%). At 1 year, 96 (23%) patients were alive. Factors independently associated with decreased 1-year survival were ICH and SAH stroke subtypes, a lower GCS score at admission, a higher non-neurological SOFA score. Conversely, patients receiving acute-phase therapy had improved 1-year survival. Intubation for acute respiratory failure or coma was associated with comparable survival hazard ratios, whereas intubation for seizure was not associated with a worse prognosis than for elective procedure. Survival did not improve over the study period, but patients included in the most recent period had more comorbidities and presented higher severity scores at admission. In acute stroke patients requiring mechanical ventilation, the reason for intubation and the opportunity to receive acute-phase stroke therapy were independently associated with 1-year survival. These variables could assist in the decision process regarding the initiation of mechanical ventilation in acute stroke patients.
Sections du résumé
BACKGROUND
BACKGROUND
Most prognostic studies in acute stroke patients requiring invasive mechanical ventilation are outdated and have limitations such as single-center retrospective designs. We aimed to study the association of ICU admission factors, including the reason for intubation, with 1-year survival of acute stroke patients requiring mechanical ventilation.
METHODS
METHODS
We conducted a secondary data use analysis of a prospective multicenter database (14 ICUs) between 1997 and 2016 on consecutive ICU stroke patients requiring mechanical ventilation at admission. We excluded patients with stroke of traumatic origin, subdural hematoma or cerebral venous thrombosis. The primary outcome was survival 1 year after ICU admission. Factors associated with the primary outcome were identified using a multivariable Cox model stratified on inclusion center.
RESULTS
RESULTS
We identified 419 patients (age 68 [58-76] years, males 60%) with a Glasgow coma score (GCS) of 4 [3-8] at admission. Stroke subtypes were acute ischemic stroke (AIS, 46%), intracranial hemorrhage (ICH, 42%) and subarachnoid hemorrhage (SAH, 12%). At 1 year, 96 (23%) patients were alive. Factors independently associated with decreased 1-year survival were ICH and SAH stroke subtypes, a lower GCS score at admission, a higher non-neurological SOFA score. Conversely, patients receiving acute-phase therapy had improved 1-year survival. Intubation for acute respiratory failure or coma was associated with comparable survival hazard ratios, whereas intubation for seizure was not associated with a worse prognosis than for elective procedure. Survival did not improve over the study period, but patients included in the most recent period had more comorbidities and presented higher severity scores at admission.
CONCLUSIONS
CONCLUSIONS
In acute stroke patients requiring mechanical ventilation, the reason for intubation and the opportunity to receive acute-phase stroke therapy were independently associated with 1-year survival. These variables could assist in the decision process regarding the initiation of mechanical ventilation in acute stroke patients.
Identifiants
pubmed: 32383104
doi: 10.1186/s13613-020-00669-5
pii: 10.1186/s13613-020-00669-5
pmc: PMC7205929
doi:
Types de publication
Journal Article
Langues
eng
Pagination
53Investigateurs
Jean-François Timsit
(JF)
Elie Azoulay
(E)
Maïté Garrouste-Orgeas
(M)
Jean-Ralph Zahar
(JR)
Christophe Adrie
(C)
Michael Darmon
(M)
Christophe Clec'h
(C)
Corinne Alberti
(C)
Adrien Français
(A)
Aurélien Vesin
(A)
Stephane Ruckly
(S)
Sébastien Bailly
(S)
Frederik Lecorre
(F)
Didier Nakache
(D)
Aurélien Van-Nieuwenhuyze
(A)
Romain Hernu
(R)
Carole Agasse
(C)
Bernard Allaouchiche
(B)
Pascal Andreu
(P)
Olivier Andremont
(O)
Laurent Argaud
(L)
Claire Ara-Somohano
(C)
Elie Azoulay
(E)
Déborah Boyer
(D)
Jean-Pierre Bedos
(JP)
Thomas Baudry
(T)
Jérome Bedel
(J)
Julien Bohé
(J)
Lila Bouadma
(L)
Jeremy Bourenne
(J)
Noel Brule
(N)
Cédric Brétonnière
(C)
Christine Cheval
(C)
Julien Carvelli
(J)
Christophe Clec'h
(C)
Elisabeth Coupez
(E)
Michael Darmon
(M)
Etienne de Montmollin
(E)
Loa Dopeux
(L)
Anne-Sylvie Dumenil
(AS)
Claire Dupuis
(C)
Jean-Marc Forel
(JM)
Marc Gainnier
(M)
Charlotte Garret
(C)
Steven Grangé
(S)
Antoine Gros
(A)
Akim Haouache
(A)
Romain Hernu
(R)
Tarik Hissem
(T)
Vivien Hon Tua Ha
(VHT)
Sébastien Jochmans
(S)
Jean-Baptiste Joffredo
(JB)
Hatem Kallel
(H)
Guillaume Lacave
(G)
Alexandre Lautrette
(A)
Virgine Lemiale
(V)
Mathilde Lermuzeaux
(M)
Guillaume Marcotte
(G)
Jordane Lebut
(J)
Maxime Lugosi
(M)
Eric Magalhaes
(E)
Sibylle Merceron
(S)
Bruno Mourvillier
(B)
Benoît Misset
(B)
Bruno Mourvillier
(B)
Mathilde Neuville
(M)
Laurent Nicolet
(L)
Johanna Oziel
(J)
Laurent Papazian
(L)
Benjamin Planquette
(B)
Jean-Pierre Quenot
(JP)
Aguila Radjou
(A)
Marie Simon
(M)
Romain Sonneville
(R)
Jean Reignier
(J)
Bertrand Souweine
(B)
Carole Schwebel
(C)
Shidasp Siami
(S)
Roland Smonig
(R)
Gilles Troché
(G)
Marie Thuong
(M)
Guillaume Thierry
(G)
Dany Toledano
(D)
Guillaume Van Der Meersch
(G)
Marion Venot
(M)
Olivier Zambon
(O)
Références
J Neurol Sci. 2000 Jun 15;176(2):83-7
pubmed: 10930588
Am J Emerg Med. 2016 Dec;34(12):2326-2330
pubmed: 27727067
Neurocrit Care. 2015 Aug;23(1):28-32
pubmed: 25487123
J Stroke Cerebrovasc Dis. 2004 Jul-Aug;13(4):183-8
pubmed: 17903973
Intensive Care Med. 2015 Oct;41(10):1763-72
pubmed: 26149302
Stroke. 2015 Jul;46(7):2032-60
pubmed: 26022637
Intensive Care Med. 2013 Aug;39(8):1396-404
pubmed: 23685609
Intensive Care Med. 2017 Feb;43(2):271-272
pubmed: 27695893
Int J Stroke. 2014 Oct;9(7):840-55
pubmed: 25156220
Stroke. 1988 May;19(5):604-7
pubmed: 3363593
Lancet Neurol. 2019 May;18(5):439-458
pubmed: 30871944
Intensive Care Med. 1996 Jul;22(7):707-10
pubmed: 8844239
Intensive Care Med. 1994;20(1):32-6
pubmed: 8163755
Lancet. 1974 Jul 13;2(7872):81-4
pubmed: 4136544
Stroke. 1997 Apr;28(4):711-5
pubmed: 9099184
Neurology. 2001 Mar 27;56(6):766-72
pubmed: 11274312
PLoS One. 2014 Feb 12;9(2):e88652
pubmed: 24533130
Intensive Care Med. 2001 Jul;27(7):1141-6
pubmed: 11534561
Am J Med Sci. 2018 Jul;356(1):3-9
pubmed: 30049327
Intensive Care Med. 2019 Sep;45(9):1177-1189
pubmed: 31346678
J Neurol. 2005 Jun;252(6):648-54
pubmed: 15742110
Crit Care Resusc. 2012 Mar;14(1):14-9
pubmed: 22404056
Stroke. 1996 Aug;27(8):1301-3
pubmed: 8711790
Stroke. 2010 May;41(5):1048-50
pubmed: 20224060
Stroke. 2018 Mar;49(3):e46-e110
pubmed: 29367334
Neurology. 1998 Aug;51(2):447-51
pubmed: 9710017
J Stroke Cerebrovasc Dis. 2016 Jul;25(7):1644-1652
pubmed: 27067880
Cochrane Database Syst Rev. 2013 Sep 11;(9):CD000197
pubmed: 24026639
Intensive Care Med. 2016 Sep;42(9):1408-17
pubmed: 27260258
Intensive Care Med. 2014 May;40(5):749-51
pubmed: 24711090
Crit Care Med. 2009 Dec;37(12):3107-13
pubmed: 19661805
JAMA. 1993 Dec 22-29;270(24):2957-63
pubmed: 8254858
Lancet. 2016 Apr 23;387(10029):1723-31
pubmed: 26898852
Stroke. 2019 Dec;50(12):e344-e418
pubmed: 31662037
J Infect. 2019 Sep;79(3):220-227
pubmed: 31238051