Prevalence, Predictors, and Outcomes of Prolonged Mechanical Ventilation After Endovascular Stroke Therapy
- PDF / 683,966 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 2 Downloads / 169 Views
ORIGINAL WORK
Prevalence, Predictors, and Outcomes of Prolonged Mechanical Ventilation After Endovascular Stroke Therapy Hamidreza Saber1* , Mohan Palla2, Shaghayegh Kazemlou3, Babak B. Navi4, Albert J. Yoo5, Claus Ziegler Simonsen6, Aubin Sandio2, Gary Rajah7, Kasra Khatibi1, David S. Liebeskind1 and Sunil A. Sheth8 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: To investigate the rates, predictors, and outcomes of prolonged mechanical ventilation (≥ 96 h) following endovascular treatment (EVT) of ischemic stroke. Methods: Hospitalizations with acute ischemic stroke and EVT were identified using validated codes in the National Inpatient Sample (2010–2015). The primary outcome was prolonged mechanical ventilation defined as ventilation ≥ 96 consecutive hours. We compared hospitalizations involving prolonged ventilation following EVT with those that did not involve prolonged ventilation. Propensity score matching was used to adjust for differences between groups. Clinical predictors of prolonged ventilation were assessed using multivariable conditional logistic regression analyses. Results: Among the 34,184 hospitalizations with EVT, 5087 (14.9%) required prolonged mechanical ventilation. There was a decline in overall intubation and prolonged ventilation during the study period. On multivariable analysis, history of heart failure [OR 1.28 (95% CI 1.05–1.57)] and diabetes [OR 1.22 (95% CI 1–1.50)] was independent predictors of prolonged ventilation following EVT. In a sensitivity analysis of anterior circulation stroke only, heart failure [OR 1.3 (95% CI 1.10–1.61)], diabetes [OR 1.25 (95% CI 1.01–1.57)], and chronic lung disease [OR 1.31 (95% CI 1.03–1.66)] were independent predictors of prolonged ventilation. The weighted proportions of in-hospital mortality, post-procedural shock, acute renal failure, and intracerebral hemorrhage were higher in the prolonged ventilation group. Conclusions: Among a nationally representative sample of hospitalizations, nearly one-in-six patients had prolonged mechanical ventilation after EVT. Heart failure and diabetes were significantly associated with prolonged mechanical ventilation following EVT. Prolonged ventilation was associated with significant increase in in-hospital mortality and morbidity. Keywords: Ischemic stroke, Endovascular therapy, Mechanical ventilation, Epidemiology Introduction Despite advances in endovascular treatment (EVT) for large vessel occlusions, a considerable number of patients *Correspondence: [email protected] 1 Department of Radiological Sciences, University of California Los Angeles, 635 Charles E Young Drive South, Suit 225, Los Angeles, CA 90095‑7334, USA Full list of author information is available at the end of the article
will not achieve favorable outcome following therapy [1]. Mechanical ventilation is frequently utilized in emergent large vessel occlusion stroke patients as part of the EVT protocol for procedural safety, or following respiratory failur
Data Loading...
