Predictors of Extubation Success in Patients with Posterior Fossa Strokes

Objective 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. Design We i...

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Bibliographic Details
Published in:Neurocritical care 2016-08, Vol.25 (1), p.117-127
Main Authors: Guru, Pramod K., Singh, Tarun D., Pedavally, Swetha, Rabinstein, Alejandro A., Hocker, Sara
Format: Article
Language:English
Subjects:
Aged
Airway Extubation - statistics & numerical data
Brain Ischemia - complications
Brain Stem - pathology
Brain Stem Infarctions - etiology
Brain Stem Infarctions - therapy
Cerebellum - pathology
Cerebral Hemorrhage - complications
Chronic obstructive pulmonary disease
Consciousness
Critical care
Critical Care Medicine
Edema
Female
Glasgow Coma Scale
Heart failure
Heart rate
Hemorrhage
Humans
Hydrocephalus
Hypertension
Intensive
Internal Medicine
Intracranial pressure
Intubation
Ischemia
Male
Medical imaging
Medicine
Medicine & Public Health
Middle Aged
Mortality
Neurology
Neurosciences
Original Article
Ostomy
Outcome Assessment, Health Care - statistics & numerical data
Palliative Care
Patients
Pneumonia
Respiration, Artificial - statistics & numerical data
Retrospective Studies
Stroke
Stroke - etiology
Stroke - therapy
Success
Suctioning
Tomography
Ventilators
Weaning
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Summary:Objective 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. Design 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. Measurements and Main Results 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. Conclusions 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.
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-016-0249-7