One-Year Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation-Reference-Cited by-同舟云学术

One-Year Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation

Published:2023-09 Issue:9 Volume:54 Page:2328-2337
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Sonneville Romain¹²^ORCID,Mazighi Mikael¹³⁴^ORCID,Collet Magalie⁵⁶^ORCID,Gayat Etienne⁵⁶^ORCID,Degos Vincent⁷⁸,Duranteau Jacques⁹,Grégoire Charles¹⁰^ORCID,Sharshar Tarek¹¹,Naim Giulia¹¹^ORCID,Cortier David¹²,Jost Paul-Henri¹³,Foucrier Arnaud¹⁴,Bagate François¹⁵^ORCID,de Montmollin Etienne¹⁶^ORCID,Papin Gregory²,Magalhaes Eric¹⁷,Guidet Bertrand¹⁸,Ben Hadj Salem Omar¹⁹,Benghanem Sarah²⁰,le Guennec Loïc²¹^ORCID,Delpierre Eric²²^ORCID,Legriel Stephane²³^ORCID,Megarbane Bruno²⁴^ORCID,Toumert Karim²⁵^ORCID,Tran Marc²⁶,Geri Guillaume²⁷,Monchi Mehran²⁸,Bodiguel Eric²⁹,Mariotte Eric³⁰,Demoule Alexandre³¹^ORCID,Zarka Jonathan³²,Diehl Jean-Luc³³,Roux Damien³⁴^ORCID,Barré Eric³⁵,Tanaka Sebastien³⁶^ORCID,Osman David³⁷,Pasquier Pierre³⁸^ORCID,Lamara Fariza²,Crassard Isabelle³⁹,Boursin Perrine⁴,Ruckly Stéphane⁴⁰,Staiquly Quentin⁴⁰,Timsit Jean-François²^ORCID,Woimant France³⁹^ORCID,Ader Tiare,Bout Hélène,Bresson Damien,Combes Alain,Chrisment Anne,Crozier Sophie,da Silva Daniel,Decavele Maxens,Dres Martin,Faugeras Frédéric,Fournier Marie-Céline,Gauss Tobias,Gernez Coralie,Hurel Dominique,Jamme Matthieu,Josse Laurence,Jurcisin Igor,Kerhuel Lionel,Lamy Catherine,Lancelot Aymeric,Lapergue Bertrand,Lenclud Christophe,Lermuzeaux Mathilde,Malissin Isabelle,Maldjian Alain,Marin Nathalie,Martin Jérôme,Martinez Thibault,Dessap Armand Mekontso,Outin Hervé,Pichereau Claire,Pissot Matthieu,Razazi Keyvan,Reuter Danielle,Richard Christian,Schimpf Caroline,Servan Jérôme,Thion Laurie-Anne,Traki Widad,Vassel Philippe,Vigué Bernard,Zafimahazo Daniel

Affiliation:

1. Université de Paris, INSERM UMR 1148, F-75018 Paris, France (R.S., M. Mazighi).

2. APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.).

3. APHP, Department of Neurology, Lariboisière University Hospital, Paris, France (M. Mazighi).

4. APHP, Department of Neuroradiology, Rothschild Hospital Foundation, Paris, France (M. Mazighi, P.B.).

5. APHP.Nord, Department of Anesthesiology and Critical Care, DMU Parabol, Université de Paris, France (M.C., E.G.).

6. UMR-S 942 “MASCOT,” Inserm, Paris, France (M.C., E.G.).

7. APHP, Department of Critical Care, Anesthesia and Perioperative Medicine, Pitié-Salpétrière University Hospital and Sorbonne Université, Paris, France (V.D.).

8. GRC ARPE, Sorbonne Université, Paris, France (V.D.).

9. APHP, Department of Anesthesiology and Critical Care, Bicêtre University Hospitals, Le Kremlin Bicêtre, France (J.D.).

10. Department of Intensive Care, Rothschild Hospital Foundation, Paris, France (C.G.).

11. Department of Neuroanesthesiology and Intensive Care, Saint Anne Hospital, Paris, France (T.S., G.N.).

12. Department of Intensive Care, Foch Hospital, Paris, France (D.C.).

13. APHP, Department of Anesthesiology and Critical Care, Henri Mondor University Hospital, Créteil, France (P.-H.J.).

14. APHP, Department of Anesthesiology and Critical Care, Beaujon University Hospital, Clichy, France (A.F.).

15. APHP, Department of Intensive Care Medicine, Henri Mondor University Hospital and Université de Paris Est Créteil, France (F.B.).

16. Department of Intensive Care Medicine, Delafontaine Hospital, Saint-Denis, France (E.d.M.).

17. Department of Intensive Care Medicine, Sud Francilien Hospital, Corbeil, France (E.M.).

18. APHP, Department of Intensive Care Medicine, Saint Antoine University Hospital, Paris, France (B.G.).

19. Department of Intensive Care Medicine, Poissy-Saint Germain en Laye Hospital, Paris, France (O.B.H.S.).

20. APHP, Medical ICU, Cochin University Hospital and Université Paris Cité, France (S.B.).

21. APHP, Department of Intensive Care Medicine, La Pitié-Salpêtrière University Hospital and Sorbonne Université, Paris, France (L.l.G.).

22. Department of Intensive Care Medicine, Meaux Hospital, France (E.D.).

23. Department of Intensive Care Medicine, Versailles Hospital, Le Chesnay, and Paris-Saclay University UVSQ, INSERM, CESP, Villejuif, France (S.L.).

24. APHP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital and INSERM UMRS-1144, Université Paris Cité, France (B.M.).

25. Department of Intensive Care Medicine, Gonesse Hospital, France (K.T.).

26. Department of Intensive Care Medicine, Paris Saint-Joseph Hospital, Paris, France (M.T.).

27. APHP, Department of Intensive Care Medicine, Ambroise Paré University Hospital, Boulogne, France (G.G.).

28. Department of Intensive Care Medicine, Melun-Senart Hospital, France (M. Monchi).

29. APHP, Emergency Department, Georges Pompidou University Hospital, Paris, France (E. Bodiguel).

30. APHP, Department of Intensive Care Medicine, Saint Louis University Hospital, Paris, France (E.M.).

31. APHP, Department of Intensive Care Medicine (R3S) and Sorbonne Université, INSERM, UMRS1158, Pitié-Salpétrière University Hospital, Paris, France (A.D.).

32. Department of Intensive Care Medicine, Lagny Hospital, France (J.Z.).

33. APHP, Department of Intensive Care Medicine, Georges Pompidou University Hospital and INSERM UMR_S 1140 Paris, France (J.-L.D.).

34. APHP, Medico-Surgical ICU, Louis Mourier University Hospital, Colombes and Université Paris Cité, IAME, INSERM, UMR1137, France (D.R.).

35. Department of Intensive Care Medicine, Mantes-la-Jolie Hospital, France (E. Barré).

36. APHP, Department of Anesthesia and Critical Care Medicine, Bichat-Claude Bernard University Hospital and INSERM UMR 1188 DéTROI, Université de la Réunion, Saint-Denis de la Réunion, France (S.T.).

37. APHP, Department of Intensive Care Medicine, Bicêtre University Hospital, Le Kremlin Bicêtre, France (D.O.).

38. Department of Anesthesiology and Critical Care, Percy Military Training Hospital, Clamart, France (P.P.).

39. Agence Régionale de Santé Ile-de-France, Paris, France (I.C., F.W.).

40. Department of Biostatistics, ICUREsearch, Paris, France (S.R., Q.S.).

Abstract

BACKGROUND: Long-term outcomes of patients with severe stroke remain poorly documented. We aimed to characterize one-year outcomes of patients with stroke requiring mechanical ventilation in the intensive care unit (ICU). METHODS: We conducted a prospective multicenter cohort study in 33 ICUs in France (2017–2019) on patients with consecutive strokes requiring mechanical ventilation for at least 24 hours. Outcomes were collected via telephone interviews by an independent research assistant. The primary end point was poor functional outcome, defined by a modified Rankin Scale score of 4 to 6 at 1 year. Multivariable mixed models investigated variables associated with the primary end point. Secondary end points included quality of life, activities of daily living, and anxiety and depression in 1-year survivors. RESULTS: Among the 364 patients included, 244 patients (66.5% [95% CI, 61.7%–71.3%]) had a poor functional outcome, including 190 deaths (52.2%). After adjustment for non-neurological organ failure, age ≥70 years (odds ratio [OR], 2.38 [95% CI, 1.26–4.49]), Charlson comorbidity index ≥2 (OR, 2.01 [95% CI, 1.16–3.49]), a score on the Glasgow Coma Scale <8 at ICU admission (OR, 3.43 [95% CI, 1.98–5.96]), stroke subtype (intracerebral hemorrhage: OR, 2.44 [95% CI, 1.29–4.63] versus ischemic stroke: OR, 2.06 [95% CI, 1.06–4.00] versus subarachnoid hemorrhage: reference) remained independently associated with poor functional outcome. In contrast, a time between stroke diagnosis and initiation of mechanical ventilation >1 day was protective (OR, 0.56 [95% CI, 0.33–0.94]). A sensitivity analysis conducted after exclusion of patients with early decisions of withholding/withdrawal of care yielded similar results. We observed persistent physical and psychological problems at 1 year in >50% of survivors. CONCLUSIONS: In patients with severe stroke requiring mechanical ventilation, several ICU admission variables may inform caregivers, patients, and their families on post-ICU trajectories and functional outcomes. The burden of persistent sequelae at 1 year reinforces the need for a personalized, multi-disciplinary, prolonged follow-up of these patients after ICU discharge. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03335995

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Reference32 articles.

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3. Cost and Outcome of Mechanical Ventilation for Life-Threatening Stroke

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5. Factors associated with withdrawal of mechanical ventilation in a neurology/neurosurgery intensive care unit

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