title: Mechanical Ventilation for Acute Stroke: A Multi-state Population-Based Study.
abstract: BACKGROUND
  Mechanical ventilation is frequently performed in patients with ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). In this study, we used statewide administrative claims data to examine the rates of use, associated conditions, and in-hospital mortality rates for mechanically ventilated stroke patients.
  
  
  METHODS
  We used statewide administrative claims data from three states and ICD-9-CM codes to identify patients admitted with stroke and those who received mechanical ventilation and tracheostomy. Descriptive statistics and exact 95 % confidence intervals were used to report rates of mechanical ventilation, tracheostomy, and in-hospital mortality. Logistic regression analysis was performed to identify conditions associated with mechanical ventilation based on previously described risk factors.
  
  
  RESULTS
  798,255 hospital admissions for stroke were identified. 12.5 % of these patients underwent mechanical ventilation. This rate varied by stroke type: 7.9 % for IS, 29.9 % for ICH, and 38.5 % for SAH. Increased age was associated with a decreased risk of receiving mechanical ventilation (RR per decade, 0.91). Of stroke patients who underwent mechanical ventilation, 16.3 % received a tracheostomy. Mechanical ventilation was more likely to occur in association with status epilepticus (RR, 5.1), pneumonia (RR, 4.9), sepsis (RR, 3.6), and hydrocephalus (RR, 3.3). In-hospital mortality rate for mechanically ventilated stroke patients was 52.7 % (46.8 % for IS, 61.0 % for ICH, and 54.6 % for SAH).
  
  
  CONCLUSIONS
  In this large population-based sample, over half of mechanically ventilated stroke patients died in the hospital despite the fact that younger patients were more likely to receive mechanical ventilation. Future studies are indicated to elucidate mechanical ventilation strategies to optimize long-term outcomes after severe stroke.
authors.affiliation: NYP/Columbia and Weill Cornell Medical Center, New York, USA, sl3657@cumc.columbia.edu.
authors.forename: Shouri
authors.initials: S
authors.lastname: Lahiri
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Fink
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Lord
authors.forename: Axel
authors.initials: A
authors.lastname: Rosengart
authors.forename: Halinder S
authors.initials: HS
authors.lastname: Mangat
authors.forename: Alan Z
authors.initials: AZ
authors.lastname: Segal
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology; D005260:Female; D005431:Florida / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000453:epidemiology