Role of clinical predictors in determining the need for mechanical ventilation in patients with acute stroke and their outcome- A Prospective observational study
DOI:
https://doi.org/10.3126/ajms.v12i6.34643Keywords:
Herniation, Ventilation, NIHSS, Predictors, GCS, Mechanical, MortalityAbstract
Background: Stroke is the third leading cause of death in developed countries and the leading cause of long term disability. As the mortality during initial few days depends upon the compression of vital organs in brain stem due to raised intracranial tension and possible herniation, treatment for impending or early herniation requires intubation and mechanical ventilation and up to 10% of patients with acute stroke need mechanical ventilation due to different reasons.
Aims and Objective: The aim of the study was to find the role of clinical predictors in determining the need for mechanical ventilation in patients with acute stroke and their outcome.
Materials and Methods: This prospective observational cohort study was conducted from September 2017 to march 2019 of patients with acute stroke admitted either through OPD or Emergency/ Triage of Max super specialty hospital, Saket, New Delhi. Patients with acute Stroke defined as the presence of sudden onset of focal neurological deficit and admitted within 24 h of onset of symptoms with Age ≥18 years were included in the study. Patients already on ventilator support at the time of admission were excluded.
Results: A total of 165 patients met the inclusion and exclusion criteria and were enrolled for the study. Out of 165 patients included in the study 43 (26.06 %) were put on the mechanical ventilation due to various reasons. Multivariate analysis of statistically significant and most clinically important variables showed the overall predictor accuracy of requirement of mechanical ventilation of 81.2% if the patients had loss of consciousness at the time of onset ( OR = 0.076) and Glasgow Coma Scale (GCS) motor score of ≤ 5 ( OR= 0.000). About 58.62% (17/29) patients who were put on ventilator support were found to have favorable outcome Modified Rankin Scale (MRS score ≤ 2) at discharge compared to 6.90% (2/29) before ventilation.
Conclusion: We concluded that loss of consciousness at onset, GCS motor score ≤ 5 (OR= 0.000) were associated with overall predictor accuracy of 81.2% in determining the need for mechanical ventilation. We found overall in-hospital mortality rate of 9.1% whereas mortality rate in patients on mechanical ventilation was 32.55%.
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