• Etienne de Montmollin, Nicolas Terzi, Claire Dupuis, Maité Garrouste-Orgeas, Daniel da Silva, Michaël Darmon, Virginie Laurent, Guillaume Thiéry, Johana Oziel, Guillaume Marcotte, Marc Gainnier, Shidasp Siami, Benjamin Sztrymf, Christophe Adrie, Jean Reignier, Stephane Ruckly, Romain Sonneville, Jean-François Timsit, and OUTCOMEREA Study Group.
• Université de Paris, UMR 1137, IAME, Paris, France. etienne.demontmollin@aphp.fr.
• Ann Intensive Care. 2020 May 7; 10 (1): 53.

BackgroundMost prognostic studies in acute stroke patients requiring invasive mechanical ventilation are outdated and have limitations such as single-center retrospective designs. We aimed to study the association of ICU admission factors, including the reason for intubation, with 1-year survival of acute stroke patients requiring mechanical ventilation.MethodsWe conducted a secondary data use analysis of a prospective multicenter database (14 ICUs) between 1997 and 2016 on consecutive ICU stroke patients requiring mechanical ventilation at admission. We excluded patients with stroke of traumatic origin, subdural hematoma or cerebral venous thrombosis. The primary outcome was survival 1 year after ICU admission. Factors associated with the primary outcome were identified using a multivariable Cox model stratified on inclusion center.ResultsWe identified 419 patients (age 68 [58-76] years, males 60%) with a Glasgow coma score (GCS) of 4 [3-8] at admission. Stroke subtypes were acute ischemic stroke (AIS, 46%), intracranial hemorrhage (ICH, 42%) and subarachnoid hemorrhage (SAH, 12%). At 1 year, 96 (23%) patients were alive. Factors independently associated with decreased 1-year survival were ICH and SAH stroke subtypes, a lower GCS score at admission, a higher non-neurological SOFA score. Conversely, patients receiving acute-phase therapy had improved 1-year survival. Intubation for acute respiratory failure or coma was associated with comparable survival hazard ratios, whereas intubation for seizure was not associated with a worse prognosis than for elective procedure. Survival did not improve over the study period, but patients included in the most recent period had more comorbidities and presented higher severity scores at admission.ConclusionsIn acute stroke patients requiring mechanical ventilation, the reason for intubation and the opportunity to receive acute-phase stroke therapy were independently associated with 1-year survival. These variables could assist in the decision process regarding the initiation of mechanical ventilation in acute stroke patients.

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