title: Outcome of survivors of acute stroke who require prolonged ventilatory assistance and tracheostomy.
abstract: OBJECTIVE
  Mechanical ventilation after stroke is associated with high mortality. However, little is known about survivors who require prolonged ventilatory assistance and tracheostomy. Our goal was to assess the rate of pulmonary complication, effect of early tracheostomy and prognosis of patients with stroke requiring prolonged ventilatory support.
  
  
  METHODS
  Retrospective review of 97 patients with stroke who required ventilatory assistance and tracheostomy admitted to a single teaching hospital between 1976 and 2000. Outcome was defined using the Glasgow Outcome Scale (GOS).
  
  
  RESULTS
  Poor outcome (GOS 1-3) occurred in 74% of patients at 1 year and it was associated with older age (p = 0.03), prior history of brain damage (p = 0.02), and neurological worsening after intubation (p < 0.01). However, long-term functional recovery (GOS 4-5) was possible and more likely after strokes involving the posterior circulation (p = 0.03). Pulmonary complications were prevalent and more frequent before tracheostomy (68 vs. 20% after tracheostomy) but did not determine functional outcome. Mean duration of mechanical ventilation was 11 +/- 19 days and did not significantly differ between outcome groups. Early tracheostomy correlated with shorter ICU and hospital stays (p < 0.01 in both cases).
  
  
  CONCLUSIONS
  Surviving patients with stroke who require prolonged ventilatory assistance and tracheostomy can have a better outcome than previously reported. Aggressive care is justified in patients who do not continue to deteriorate neurologically. Pulmonary complications are frequent but treatable. Early tracheostomy can shorten ICU and hospital stays and reduce costs.
authors.affiliation: Department of Neurology and the Neurological-Neurosurgical ICU, Saint Mary's Hospital, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects; D012140:Respiratory Tract Diseases / Q000209:etiology*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects; D016896:Treatment Outcome