title: Predictors of Extubation Success in Patients with Posterior Fossa Strokes.
abstract: Posterior fossa stroke is unique in its presentation and outcomes, and mechanical ventilation is commonly used in the management of these patients. We aimed to identify predictors of extubation success in patients with posterior fossa stroke, who require mechanical ventilation.
  
  
  
  We included consecutive adult patients admitted to the neurosciences ICU from January 2003 to December 2012. Extubation failure was defined as re-intubation within 7 days of extubation. A modified Rankin Scale score of 0-3 was considered a good outcome.
  
  
  
  We identified 150 patients with mean age of 65 ± 15.7 years with posterior fossa strokes; 77 (51 %) were hemorrhagic, and 73 (49 %) were ischemic. The most common reason for intubation was depressed consciousness (54 %). Fifty-two (35 %) were successfully extubated, 18 (12 %) failed extubation, 17 (11 %) patients had tracheostomy without attempted extubation, and 63 (42 %) were transitioned to palliative care prior to extubation. In the logistic regression analysis, controlling for transition to palliative care, Glasgow Coma Score (GCS) score >6 at the time of intubation (p = 0.020), mechanical ventilation for less than 7 days (p = 0.004), and surgical evacuation of a hematoma (p = 0.058) were independently associated with successful extubation. The presence of cough, gag reflex, and absence of pneumonia/atelectasis were not associated with successful extubation. Success of extubation predicted a good outcome at hospital discharge.
  
  
  
  In posterior fossa stroke patients with a GCS ≤ 6 at the time of intubation and who remain intubated for more than 1 week, extubation is less likely to be successful, and tracheostomy should be considered.
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA. guru.pramod@mayo.edu.
authors.forename: Pramod K
authors.initials: PK
authors.lastname: Guru
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Tarun D
authors.initials: TD
authors.lastname: Singh
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Swetha
authors.initials: S
authors.lastname: Pedavally
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Hocker
mesh_terms: D000368:Aged; D060666:Airway Extubation / Q000706:statistics & numerical data*; D002545:Brain Ischemia / Q000150:complications; D001933:Brain Stem / Q000473:pathology*; D020526:Brain Stem Infarctions / Q000209:etiology / Q000628:therapy; D002531:Cerebellum / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000150:complications; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010166:Palliative Care; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000628:therapy*
keywords: Extubation; Posterior fossa; Predictors; Stroke