title: Outcome of Intensive Care Unit-Dependent, Tracheotomized Patients with Cerebrovascular Diseases.
abstract: BACKGROUND
  Outcome studies in intensive care unit -dependent, tracheotomized, and mechanical ventilated patients with cerebrovascular disease (CVD) are scarce.
  
  
  METHODS
  In a retrospective approach, we analyzed the outcome of 143 patients with ischemic stroke (IS), primary intracerebral hemorrhage (PICH), and subarachnoid hemorrhage (SAH). To measure the potential benefit of in-patient rehabilitation, we used the Functional Independence Measure (FIM). In addition, weaning and rehabilitation duration, duration of mechanical ventilation (MV) in the acute care hospital (preweaning), and mortality rates were assessed.
  
  
  RESULTS
  Approximately 50% of all patients were transferred home. These patients were fully independent or under nursing support. We found no differences regarding weaning and rehabilitation durations, or FIM scores in between each entity. Log-regression analyses showed that every day on MV generates a 3.2% reduction of the possibility to achieve a beneficial outcome (FIM ≥ 50 points [only moderate assistance necessary]), whereas every day in-patient rehabilitation without MV increases the chance for favorable outcome by 1.9%. Mortality rates were 5% for IS and 10% for PICH and SAH, respectively.
  
  
  CONCLUSIONS
  This study shows that even severely affected, tracheotomized patients with CVD benefit from early in-patient rehabilitation, irrespective of the etiology of vascular brain injury. Mortality rates of early rehabilitation in CVD are low. Until no validated outcome predictors are available, all efforts should be undertaken to enable in-patient rehabilitation, even in severe cases of CVD to improve outcome and to prevent accommodation in long-time-care facilities.
authors.affiliation: Helios Klinik Kipfenberg, Kipfenberg, Germany; Neurologische Universitätsklinik Marburg, Philipps-Universität Marburg, Marburg, Germany. Electronic address: matthiasponfick@web.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Ponfick
authors.affiliation: Helios Klinik Kipfenberg, Kipfenberg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Wiederer
authors.affiliation: Helios Klinik Kipfenberg, Kipfenberg, Germany; Neurologische Universitätsklinik Marburg, Philipps-Universität Marburg, Marburg, Germany.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Nowak
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000534:rehabilitation*; D003422:Critical Care; D004185:Disability Evaluation; D005260:Female; D006701:Home Nursing; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010360:Patient Transfer; D020127:Recovery of Function; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000628:therapy; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome; D015300:Ventilator Weaning
keywords: Stroke; intensive care unit; intracerebral hemorrhage; outcome; rehabilitation; subarachnoid hemorrhage