Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation: Predictors of Mortality and Successful Extubation

Background: The majority of patients with acute stroke requiring mechanical ventilation have a poor prognosis and often present difficult decisions regarding extubation. The best criteria for planned extubation in these patients are uncertain. Methods: We reviewed the electronic medical records of patients hospitalized between 1/1/2010 and 12/15/2015 with acute stroke requiring mechanical ventilation to determine the mortality rate, the respiratory parameters recorded prior to planned extubation, and the reintubation rate. Results: This study included 226 patients. The mean age was 60.3 +/- 14.3 years. The mean duration of mechanical ventilation was 6.5 +/- 5.9 days. The overall in-hospital mortality rate was 56.6%. The best predictors of mortality were age and stroke volume calculated from radiographic images. One hundred and one patients had planned extubations; 9 patients (8.9%) required reintubation. There was no difference in respiratory parameters or Glasgow coma scale scores between those patients with successful extubation and those patients with failed extubation. Conclusions: The in-hospital mortality rate of patients with acute stroke who require mechanical ventilation is quite high. The success rate with planned extubation is relatively good and comparable to rates in previous studies which largely involved patients with respiratory failure. There is no single weaning parameter or Glasgow coma scale score which identifies patients with high success rates.