One-Year Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation
Authors: Sonneville Romain , Mazighi Mikael , Collet Magalie , Gayat Etienne , Degos Vincent , Duranteau Jacques , Grégoire Charles , Sharshar Tarek , Naim Giulia , Cortier David , Jost Paul-Henri , Foucrier Arnaud , Bagate François , de Montmollin Etienne , Papin Gregory , Magalhaes Eric , Guidet Bertrand , Ben Hadj Salem Omar , Benghanem Sarah , le Guennec Loïc , Delpierre Eric , Legriel Stephane , Megarbane Bruno , Toumert Karim , Tran Marc , Geri Guillaume , Monchi Mehran , Bodiguel Eric , Mariotte Eric , Demoule Alexandre , Zarka Jonathan , Diehl Jean-Luc , Roux Damien , Barré Eric , Tanaka Sebastien , Osman David , Pasquier Pierre , Lamara Fariza , Crassard Isabelle , Boursin Perrine , Ruckly Stéphane , Staiquly Quentin , Timsit Jean-François , Woimant France , 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 
Published: July 2023

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