Survival and quality of life outcome after mechanical ventilation in elderly stroke patients.
OBJECTIVE
Mortality is high and functional outcome poor in mechanically ventilated stroke patients. In addition, age >65 years is an independent predictor of death at 2 months among these patients. Our objective was to determine survival rates, functional outcome, and quality of life (QoL) in stroke patients older than 65 years requiring mechanical ventilation.


METHODS
A prospective cohort study with an additional cross-sectional survey in 65 patients aged 65 years and older (mean age (SD): 75.6 (6.0) years) with ischaemic or haemorrhagic stroke who underwent mechanical ventilation. Main outcome measures were survival rate at 6 months, and Barthel Index (BI), modified Rankin Scale, and QoL at 15.8 (SD 8.0) months.


RESULTS
Survival rate at 6 months was 40%. Elective intubation (odds ratio (OR) 13.6; p = 0.002) was the only independent positive predictor for survival, while age >77.5 years (OR 0.1; p = 0.004) and white blood count >10/nl at admission (OR 0.31; p = 0.032) were independent negative predictors for survival at 6 months. At the time of the cross-sectional survey, BI was >70 in five out of 22 patients, 35-70 in three and <35 in the remaining 14 patients. QoL was impaired primarily in the physical domain, whereas the psychosocial domain was less affected.


CONCLUSIONS
Although only 40% of elderly patients intubated in the acute phase of stroke survived at least 6 months, one in four survivors recovered to a good functional outcome with a reasonable QoL. Elderly stroke patients need to be selected carefully for intensive care treatment, but elective intubation to allow diagnostic procedures should not be withheld primarily based on their age.
Foerch
C
C
Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. foerch@em.uni-frankfurt.de
Kessler
K R
KR
Steckel
D A
DA
Steinmetz
H
H
Sitzer
M
M
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D011788:Quality of Life; D012121:Respiration, Artificial / Q000523:psychology*; D012131:Respiratory Insufficiency / Q000503:physiopathology* / Q000534:rehabilitation*; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000401:mortality*; D015996:Survival Rate