title: Functional, cognitive and emotional long-term outcome of patients with ischemic stroke requiring mechanical ventilation.
abstract: Prognosis of patients with ischemic stroke requiring mechanical ventilation (MV) has been reported to be poor. However, longterm survival and functional outcome have scarcely been studied and nothing is known about the prevalence of cognitive impairment or depression in survivors and their quality of life (QoL). We identified all patients treated for acute ischemic stroke on a Neurological Intensive Care Unit during 3.5 years who required MV for more than 24 hours. Early mortality rate at 2 months and survival rates at 1 and 2 years were determined. Survivors were examined for functional outcome (modified Rankin Scale (mRS), Barthel Index), cognitive impairment (Mini Mental State Examination (MMSE)), depression (Beck Depression Inventory, BDI) and QoL (Short Form-36). Clinical characteristics on admission were analyzed for prognostic significance. Of 101 consecutive patients, 44% died within 60 days. Survival rates at 1 and 2 years were 40% and 33%, respectively. Age > 60 years (p = 0.002) and Glasgow Coma Scale score < 10 on admission (p = 0.002) were independent predictors of early and late mortality. History of myocardial infarction (p = 0.007) independently predicted late mortality at 2 years. Of 33 surviving patients, nine (27%) had a good functional outcome (mRS 0-2). Of 27 survivors who could be interviewed, 17 (63%) had no cognitive impairment (MMSE > 24) and 20 (74%) did not suffer from relevant depression (BDI < 19). In conclusion, longer-term survival of patients with ischemic stroke requiring MV was 33% and every fourth survivor resumed an independent life without dementia or depression. Older patients comatose on admission and with concomitant cardiovascular disease had the lowest probability of a favorable outcome.
authors.affiliation: Klinik für Neurologie, Vivantes Auguste-Viktoria-Klinikum, Rubensstrasse 125, 12157 Berlin, Germany. eva.schielke@vivantes.de
authors.forename: Eva
authors.initials: E
authors.lastname: Schielke
authors.forename: Markus A
authors.initials: MA
authors.lastname: Busch
authors.forename: Thomas
authors.initials: T
authors.lastname: Hildenhagen
authors.forename: Martin
authors.initials: M
authors.lastname: Holtkamp
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Küchler
authors.forename: Lutz
authors.initials: L
authors.lastname: Harms
authors.forename: Florian
authors.initials: F
authors.lastname: Masuhr
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003071:Cognition / Q000502:physiology*; D004644:Emotions / Q000502:physiology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D015996:Survival Rate
references.citation: Neurology. 2000 Mar 14;54(5):1124-31
references.pmid: 10720286
references.citation: Cochrane Database Syst Rev. 2002;(1):CD000197
references.pmid: 11869570
references.citation: Stroke. 2002 Aug;33(8):2053-9
references.pmid: 12154262
references.citation: Clin Rehabil. 2003 Mar;17(2):158-66
references.pmid: 12625656
references.citation: Stroke. 2000 Dec;31(12 ):2995-3000
references.pmid: 11108762
references.citation: Stroke. 1988 May;19(5):604-7
references.pmid: 3363593
references.citation: Neurology. 1998 Aug;51(2):447-51
references.pmid: 9710017
references.citation: Gesundheitswesen. 1999 Dec;61 Spec No:S184-90
references.pmid: 10726419
references.citation: Stroke. 1998 Sep;29(9):1888-93
references.pmid: 9731614
references.citation: Crit Care Med. 2000 Aug;28(8):2956-61
references.pmid: 10966278
references.citation: Mayo Clin Proc. 1997 Mar;72(3):210-3
references.pmid: 9070194
references.citation: Intensive Care Med. 2001 Jul;27(7):1141-6
references.pmid: 11534561
references.citation: Neurology. 1996 Sep;47(3):657-9
references.pmid: 8797459
references.citation: Stroke. 2000 Oct;31(10):2346-53
references.pmid: 11022062
references.citation: Stroke. 2003 Apr;34(4):1046-50
references.pmid: 12649523
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: Md State Med J. 1965 Feb;14:61-5
references.pmid: 14258950
references.citation: Arch Gen Psychiatry. 1961 Jun;4:561-71
references.pmid: 13688369
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Minerva Med. 2000 May-Jun;91(5-6):99-104
references.pmid: 11084843
references.citation: Soc Sci Med. 1995 Nov;41(10):1359-66
references.pmid: 8560303
references.citation: Br J Psychiatry. 1979 Apr;134:382-9
references.pmid: 444788
references.citation: J Neurol Neurosurg Psychiatry. 2001 Feb;70(2):226-8
references.pmid: 11160473
references.citation: J Neurol Neurosurg Psychiatry. 1994 Feb;57(2):202-7
references.pmid: 8126506
references.citation: Intensive Care Med. 1994;20(1):32-6
references.pmid: 8163755
references.citation: J Neurol Sci. 2000 Jun 15;176(2):83-7
references.pmid: 10930588
references.citation: J Neurol. 2002 Sep;249(9):1183-90
references.pmid: 12242536
references.citation: Neurology. 1995 Apr;45(4):640-4
references.pmid: 7723948
references.citation: Neurology. 1999 Apr 22;52(7):1374-81
references.pmid: 10227620
references.citation: Lancet. 1974 Jul 13;2(7872):81-4
references.pmid: 4136544
references.citation: J Am Geriatr Soc. 2002 Apr;50(4):700-6
references.pmid: 11982671
references.citation: Stroke. 1989 Jul;20(7):864-70
references.pmid: 2749846
references.citation: Stroke. 2003 Jan;34(1):138-43
references.pmid: 12511765
references.citation: Stroke. 1997 Apr;28(4):711-5
references.pmid: 9099184
references.citation: Arch Phys Med Rehabil. 2003 Apr;84(4):551-8
references.pmid: 12690594