Predictors of extubation success in acute ischemic stroke patients

Published on Sep 1, 2016in Journal of the Neurological Sciences2.651
· DOI :10.1016/j.jns.2016.07.017
Vasileios-Arsenios Lioutas10
Estimated H-index: 10
(BIDMC: Beth Israel Deaconess Medical Center),
Khalid A. Hanafy15
Estimated H-index: 15
(BIDMC: Beth Israel Deaconess Medical Center),
Sandeep Kumar16
Estimated H-index: 16
(BIDMC: Beth Israel Deaconess Medical Center)
Abstract Background Acute ischemic stroke (AIS) patients often undergo intubation and mechanical ventilation (MV). Prolonged intubation and MV have disadvantages and complications. Conventional extubation criteria based only on respiratory parameters are insufficient to guide extubation practices in stroke patients where capacity for airway protection is a major concern. Objective To identify clinical and neuroanatomical markers of successful extubation in AIS patients requiring MV. Methods Retrospective review of tertiary care hospital patient database from May 2009–November 2012 to identify consecutive patients with AIS intubated during hospitalization. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness, facial weakness, dysarthria, neglect, infarct location, dysphagia, respiratory parameters and history of pneumonia on successful extubation by hospital discharge using multivariate logistic regression analysis. Results 112 subjects met study criteria and were included in the analysis. Age and NIHSS scores (mean ± standard deviation) were 74.5 ± 16.1 years and 19 ± 9.8, respectively; 56% were women. In multivariate analysis, NIHSS score ≤ 15 (Odds Ratio 4.6, 95% Confidence Interval 1.9–11.3, p  Conclusions Milder stroke and absence of dysarthria prior to intubation were independently associated with extubation success. Our findings could help inform extubation practices in patients with AIS though prospective validation is necessary.
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