title: Predictors of extubation success in acute ischemic stroke patients.
abstract: BACKGROUND
  Acute ischemic stroke (AIS) patients often undergo intubation and mechanical ventilation (MV). Prolonged intubation and MV have disadvantages and complications. Conventional extubation criteria based only on respiratory parameters are insufficient to guide extubation practices in stroke patients where capacity for airway protection is a major concern.
  
  
  OBJECTIVE
  To identify clinical and neuroanatomical markers of successful extubation in AIS patients requiring MV.
  
  
  METHODS
  Retrospective review of tertiary care hospital patient database from May 2009-November 2012 to identify consecutive patients with AIS intubated during hospitalization. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness, facial weakness, dysarthria, neglect, infarct location, dysphagia, respiratory parameters and history of pneumonia on successful extubation by hospital discharge using multivariate logistic regression analysis.
  
  
  RESULTS
  112 subjects met study criteria and were included in the analysis. Age and NIHSS scores (mean±standard deviation) were 74.5±16.1years and 19±9.8, respectively; 56% were women. In multivariate analysis, NIHSS score≤15 (Odds Ratio 4.6, 95% Confidence Interval 1.9-11.3, p<0.001) and absence of dysarthria prior to intubation (Odds Ratio 3.0, 95% Confidence interval 1.1-8.3, p=0.04) were independently associated with successful extubation. Conventional respiratory parameters had no effect on extubation success in this cohort.
  
  
  CONCLUSIONS
  Milder stroke and absence of dysarthria prior to intubation were independently associated with extubation success. Our findings could help inform extubation practices in patients with AIS though prospective validation is necessary.
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States. Electronic address: vlioutas@bidmc.harvard.edu.
authors.forename: Vasileios-Arsenios
authors.initials: VA
authors.lastname: Lioutas
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Hanafy
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D060666:Airway Extubation; D002545:Brain Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D016208:Databases, Factual; D004401:Dysarthria / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D015999:Multivariate Analysis; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Acute ischemic stroke; Extubation; Tracheostomy