title: Prolonged mechanical ventilation is associated with pulmonary complications, increased length of stay, and unfavorable discharge destination among patients with subdural hematoma.
abstract: BACKGROUND
  Although subdural hematoma (SDH) is common in neurocritical practice, little is known about SDH patients requiring prolonged mechanical ventilation (PMV). We aimed to determine predictors of PMV and its relationship with outcome in patients with SDH.
  
  
  METHODS
  SDH patients admitted to Rush University neurointensive care unit from January 2009 to March 2012 were reviewed. Duration of intubation, pulmonary complications, demographics, treatment, discharge disposition, and length of stay (LOS) were reviewed. PMV was defined as duration of intubation >4 days. Univariate and multivariate analyses were performed to identify predictors of PMV and association with outcome among survivors with SDH.
  
  
  RESULTS
  Of the 288 survivors with SDH, the mean age was 68, and of them 179 were male. A total of 137 required surgical SDH evacuation. Pneumonia occurred in 26 patients. Forty-eight patients (17%) required intubation, with duration of intubation being 1 to 20 days (median 3.0). Factors independently associated with PMV included alcohol abuse (OR, 4.31; 95% CI, 1.36-13.67), admission GCS<15 (OR, 11; 95% CI, 2.36-51.52), and surgical evacuation (OR, 9.27; 95% CI, 1.93-44.54). PMV predicted pneumonia (OR, 5.85; 95% CI, 1.52-22.57), tracheostomy (OR, 26.67; 95% CI, 2.93-242.67), increased LOS, and unfavorable discharge destination (OR, 73.1; 95% CI, 14.03-380.69).
  
  
  CONCLUSIONS
  PMV is associated with pulmonary complications, increased LOS, and unfavorable discharge destination in patients with SDH. Alcohol abuse, admission GCS, and surgical evacuation are associated with PMV among patients with SDH. Future studies should investigate the role of early tracheostomy in high-risk patients and impact on outcomes.
authors.affiliation: Departments of *Neurological Sciences, Section of Neurocritical Care †Neurological Sciences, Rush University Medical Center, Chicago, IL.
authors.forename: Katharina M
authors.initials: KM
authors.lastname: Busl
authors.forename: Bichun
authors.initials: B
authors.lastname: Ouyang
authors.forename: Torrey A
authors.initials: TA
authors.lastname: Boland
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pollandt
authors.forename: Richard E
authors.initials: RE
authors.lastname: Temes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006408:Hematoma, Subdural / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010351:Patient Discharge; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011859:Radiography; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D017741:Survivors; D016896:Treatment Outcome; D015300:Ventilator Weaning; D055815:Young Adult