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

被引：2

作者：

Sonneville, Romain ^{[1
,2
,51
]}

Mazighi, Mikael ^{[1
,3
,4
,50
]}

Collet, Magalie ^{[5
,6
]}

Gayat, Etienne ^{[5
,6
]}

Degos, Vincent ^{[7
,8
,9
]}

Duranteau, Jacques ^{[10
]}

Gregoire, Charles ^{[11
]}

Sharshar, Tarek ^{[12
]}

Naim, Giulia ^{[12
]}

Cortier, David ^{[13
]}

Jost, Paul-Henri ^{[14
]}

Foucrier, Arnaud ^{[15
]}

Bagate, Francois ^{[16
,17
]}

de Montmollin, Etienne ^{[18
]}

Papin, Gregory ^{[2
]}

Magalhaes, Eric ^{[19
]}

Guidet, Bertrand ^{[20
]}

Salem, Omar Ben Hadj ^{[21
]}

Benghanem, Sarah ^{[22
,23
]}

le Guennec, Loic ^{[8
,24
]}

Delpierre, Eric ^{[25
]}

Legriel, Stephane ^{[26
,27
]}

Megarbane, Bruno ^{[28
,29
]}

Toumert, Karim ^{[30
]}

Tran, Marc ^{[31
]}

Geri, Guillaume ^{[32
]}

Monchi, Mehran ^{[33
]}

Bodiguel, Eric ^{[34
]}

Mariotte, Eric ^{[35
]}

Demoule, Alexandre ^{[36
,37
]}

Zarka, Jonathan ^{[38
]}

Diehl, Jean-Luc ^{[39
,40
]}

Roux, Damien ^{[41
,42
]}

Barre, Eric ^{[43
]}

Tanaka, Sebastien ^{[44
,45
]}

Osman, David ^{[46
]}

Pasquier, Pierre ^{[47
]}

Lamara, Fariza ^{[2
]}

Crassard, Isabelle ^{[48
]}

Boursin, Perrine ^{[4
]}

Ruckly, Stephane ^{[49
]}

Staiquly, Quentin ^{[49
]}

Timsit, Jean-Francois ^{[2
]}

Woimant, France ^{[48
]}

机构：

[1] Univ Paris, INSERM, UMR 1148, F-75018 Paris, France

[2] Bichat Claude Bernard Univ Hosp, APHP, Dept Intens Care Med, F-75018 Paris, France

[3] Lariboisiere Univ Hosp, APHP, Dept Neurol, Paris, France

[4] Rothschild Hosp Fdn, APHP, Dept Neuroradiol, Paris, France

[5] Univ Paris, APHP Nord, DMU Parabol, Dept Anesthesiol & Crit Care, Paris, France

[6] Inserm, UMR S 942, MASCOT, Paris, France

[7] Pitie Salpetriere Univ Hosp, APHP, Dept Crit Care Anesthesia & Perioperat Med, Paris, France

[8] Sorbonne Univ, Paris, France

[9] Sorbonne Univ, GRC ARPE, Paris, France

[10] Bicetre Univ Hosp, APHP, Dept Anesthesiol & Crit Care, Le Kremlin Bicetre, France

[11] Rothschild Hosp Fdn, Dept Intens Care, Paris, France

[12] St Anne Hosp, Dept Neuroanesthesiol & Intens Care, Paris, France

[13] Foch Hosp, Dept Intens Care, Paris, France

[14] Henri Mondor Univ Hosp, APHP, Dept Anesthesiol & Crit Care, Creteil, France

[15] Beaujon Univ Hosp, APHP, Dept Anesthesiol & Crit Care, Clichy, France

[16] Henri Mondor Univ Hosp, APHP, Dept Intens Care Med, Creteil, France

[17] Univ Paris Est Creteil, Creteil, France

[18] Delafontaine Hosp, Dept Intens Care Med, St Denis, France

[19] Sud Francilien Hosp, Dept Intens Care Med, Corbeil Essonnes, France

[20] St Antoine Univ Hosp, APHP, Dept Intens Care Med, Paris, France

[21] Poissy St Germain Laye Hosp, Dept Intens Care Med, Paris, France

[22] Cochin Univ Hosp, APHP, Med ICU, Paris, France

[23] Univ Paris Cite, Paris, France

[24] La Pitie Salpetriere Univ Hosp, APHP, Dept Intens Care Med, Paris, France

[25] Meaux Hosp, Dept Intens Care Med, Meaux, France

[26] Versailles Hosp, Dept Intens Care Med, Le Chesnay, France

[27] Paris Saclay Univ UVSQ, INSERM, CESP, Villejuif, France

[28] Univ Paris Cite, Lariboisiere Hosp, APHP, Dept Med & Toxicol Crit Care, Paris, France

[29] Univ Paris Cite, INSERM, UMRS 1144, Paris, France

[30] Gonesse Hosp, Dept Intens Care Med, Gonesse, France

[31] Paris St Joseph Hosp, Dept Intens Care Med, Paris, France

[32] Ambroise Pare Univ Hosp, APHP, Dept Intens Care Med, Boulogne, France

[33] Melun Senart Hosp, Dept Intens Care Med, Melun, France

[34] Georges Pompidou Univ Hosp, APHP, Emergency Dept, Paris, France

[35] St Louis Univ Hosp, APHP, Dept Intens Care Med, Paris, France

[36] APHP, Dept Intens Care Med R3S, Paris, France

[37] Sorbonne Univ, Pitie Salpetriere Univ Hosp, INSERM, UMRS1158, Paris, France

[38] Lagny Hosp, Dept Intens Care Med, Lagny Sur Marne, France

[39] Georges Pompidou Univ Hosp, APHP, Dept Intens Care Med, Paris, France

[40] INSERM, UMRS 1140, Paris, France

[41] Louis Mourier Univ Hosp, APHP, Med Surg ICU, Colombes, France

[42] Univ Paris Cite, IAME, INSERM, UMR1137, Paris, France

[43] Mantes La Jolie Hosp, Dept Intens Care Med, Mantes La Jolie, France

[44] Univ Reunion, Bichat Claude Bernard Univ Hosp, APHP, Dept Anesthesia & Crit Care Med, St Denis De La Reunion, France

[45] Univ Reunion, INSERM, UMR 1188, DeTROI, St Denis De La Reunion, France

[46] Bicetre Univ Hosp, APHP, Dept Intens Care Med, Le Kremlin Bicetre, France

[47] Percy Mil Training Hosp, Dept Anesthesiol & Crit Care, Clamart, France

[48] Agence Reg Sante Ile Defrance, Paris, France

[49] ICUREs, Dept Biostat, Paris, France

[50] Hop Lariboisiere, APHP, Serv Neurol, 2 Rue Ambroise Pare, F-75010 Paris, France

来源：

STROKE | 2023年 / 54卷 / 09期

关键词：

Glasgow Coma Scale; intensive care units; prognosis; quality of life; respiration; artificial; stroke; survivors; HEALTH-CARE PROFESSIONALS; LONG-TERM OUTCOMES; INTRACEREBRAL HEMORRHAGE; ISCHEMIC-STROKE; GUIDELINES; SCORE; MANAGEMENT; TELEPHONE; PROGNOSIS; MORTALITY;

D O I：

10.1161/STROKEAHA.123.042910

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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

引用

页码：2328 / 2337

页数：10

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