title: Clinical Impact of Ventilation Duration in Patients with Stroke Undergoing Interventional Treatment under General Anesthesia: The Shorter the Better?
abstract: Whether general anesthesia for neurothrombectomy in patients with ischemic stroke has a negative impact on clinical outcome is currently under discussion. We investigated the impact of early extubation and ventilation duration in a cohort that underwent thrombectomy under general anesthesia.
  
  
  
  We analyzed 103 consecutive patients from a prospective stroke registry. They met the following criteria: CTA-proved large-vessel occlusion in the anterior circulation, ASPECTS above 6 on presenting cranial CT, revascularization by thrombectomy with the patient under general anesthesia within 6 hours after onset of symptoms, and available functional outcome (mRS) 90 days after onset.
  
  
  
  The mean ventilation time was 128.07 ± 265.51 hours (median, 18.5 hours; range, 1-1244.7 hours). Prolonged ventilation was associated with pneumonia during hospitalization and unfavorable functional outcome (mRS ≥3) and death at follow-up (Mann-Whitney U test; P ≤ .001). According to receiver operating characteristic analysis, a cutoff after 24 hours predicted unfavorable functional outcome with a sensitivity and specificity of 60% and 78%, respectively. Our results imply that delayed extubation was not associated with a less favorable clinical outcome compared with immediate extubation after the procedure.
  
  
  
  Short ventilation times are associated with a lower pneumonia rate and more favorable clinical outcome. Cautious interpretation of our data implies that whether patients are extubated immediately after the procedure is irrelevant for clinical outcome as long as ventilation does not exceed 24 hours.
authors.affiliation: From the Departments of Neuroradiology (O.N., T.P., M.M., J.P.A., M.W.) Institute of Neuroscience and Medicine 4 (O.N.), Forschungszentrum Jülich, Jülich, Germany onikoubashman@ukaachen.de.
authors.forename: O
authors.identifier: 0000-0002-2055-4217
authors.initials: O
authors.lastname: Nikoubashman
authors.affiliation: Neurology (K.S., S.T., A.R.), University Hospital Aachen, Aachen, Germany.
authors.forename: K
authors.identifier: 0000-0002-3835-0327
authors.initials: K
authors.lastname: Schürmann
authors.affiliation: From the Departments of Neuroradiology (O.N., T.P., M.M., J.P.A., M.W.).
authors.forename: T
authors.identifier: 0000-0002-8118-4096
authors.initials: T
authors.lastname: Probst
authors.affiliation: From the Departments of Neuroradiology (O.N., T.P., M.M., J.P.A., M.W.).
authors.forename: M
authors.identifier: 0000-0001-8787-8294
authors.initials: M
authors.lastname: Müller
authors.affiliation: From the Departments of Neuroradiology (O.N., T.P., M.M., J.P.A., M.W.).
authors.forename: J P
authors.identifier: 0000-0002-7697-021X
authors.initials: JP
authors.lastname: Alt
authors.affiliation: Department of Radiology (A.E.O.), University Hospital Tübingen, Tübingen, Germany.
authors.forename: A E
authors.identifier: 0000-0002-3827-8695
authors.initials: AE
authors.lastname: Othman
authors.affiliation: Neurology (K.S., S.T., A.R.), University Hospital Aachen, Aachen, Germany.
authors.forename: S
authors.identifier: 0000-0001-9149-3071
authors.initials: S
authors.lastname: Tauber
authors.affiliation: From the Departments of Neuroradiology (O.N., T.P., M.M., J.P.A., M.W.).
authors.forename: M
authors.identifier: 0000-0002-8261-5513
authors.initials: M
authors.lastname: Wiesmann
authors.affiliation: Neurology (K.S., S.T., A.R.), University Hospital Aachen, Aachen, Germany.
authors.forename: A
authors.identifier: 0000-0002-9439-7963
authors.initials: A
authors.lastname: Reich
mesh_terms: D000368:Aged; D060666:Airway Extubation; D000768:Anesthesia, General / Q000379:methods*; D002548:Cerebral Revascularization; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D015607:Stents; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
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