title: Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year.
abstract: OBJECTIVE
  To assess the prognosis of patients with acute ischemic stroke who require mechanical ventilation and to determine early factors influencing mortality.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Medical intensive care unit with a cerebrovascular emergency unit in a university-affiliated hospital.
  
  
  METHODS
  Fifty-eight consecutive patients (mean age 65+/-13 years) requiring mechanical ventilation in the early course of an acute ischemic stroke.
  
  
  RESULTS
  Clinical data were recorded before intubation according to a standardized procedure. Mortality and functional outcome were assessed after a 1-year follow-up. Mechanical ventilation was started within 48 h after admission in 53 patients (91.4%). The mean duration of ventilation was similar in survivors (9.7+/-9.0 days) and non-survivors (8.6+/-8.7 days). Mortality was 72.4% at 1 year. Among the 16 survivors, none were in a persistent vegetative state and 11 had a Barthel index of 60, reflecting good functional status. Bilateral absence of corneal reflex and bilateral absence of pupillary light reflex had a positive predictive value of death of 1 (95% CI 0.78-1.00 and 0.74-1.00, respectively). After Cox regression analysis, presence of stupor or coma (OR 2.6, 95% CI 1.5-5.0), bilateral absence of corneal reflex before intubation (OR 3.4, 95% CI 1.4-8.7) and presence of ischemic cardiopathy (OR 2.8, 95% CI 1.4-5.5) were independent predictors of mortality.
  
  
  CONCLUSIONS
  Systematic withholding of endotracheal intubation in patients with AIS is not recommended. Careful and rigorous neurologic examination, including assessment of brain stem reflexes, might help to identify patients with a very high probability of death despite mechanical ventilation.
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier de Poissy-Saint Germain en Laye, France.
authors.forename: F
authors.initials: F
authors.lastname: Santoli
authors.forename: B
authors.initials: B
authors.lastname: De Jonghe
authors.forename: J
authors.initials: J
authors.lastname: Hayon
authors.forename: B
authors.initials: B
authors.lastname: Tran
authors.forename: M
authors.initials: M
authors.lastname: Piperaud
authors.forename: J
authors.initials: J
authors.lastname: Merrer
authors.forename: H
authors.initials: H
authors.lastname: Outin
mesh_terms: D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome