Predictors of Extubation Success in Patients with Posterior Fossa Strokes

Pramod K. Guru, Tarun D. Singh, Swetha Pedavally, Alejandro A. Rabinstein, Sara Hocker

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)117-127
Number of pages11
JournalNeurocritical Care
Volume25
Issue number1
DOIs
StatePublished - Aug 1 2016
Externally publishedYes

Fingerprint

Stroke
Intubation
Artificial Respiration
Tracheostomy
Palliative Care
Pulmonary Atelectasis
Neurosciences
Coma
Consciousness
Cough
Hematoma
Reflex
Pneumonia
Logistic Models
Regression Analysis

Keywords

  • Extubation
  • Posterior fossa
  • Predictors
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Predictors of Extubation Success in Patients with Posterior Fossa Strokes. / Guru, Pramod K.; Singh, Tarun D.; Pedavally, Swetha; Rabinstein, Alejandro A.; Hocker, Sara.

In: Neurocritical Care, Vol. 25, No. 1, 01.08.2016, p. 117-127.

Research output: Contribution to journalArticle

Guru, Pramod K. ; Singh, Tarun D. ; Pedavally, Swetha ; Rabinstein, Alejandro A. ; Hocker, Sara. / Predictors of Extubation Success in Patients with Posterior Fossa Strokes. In: Neurocritical Care. 2016 ; Vol. 25, No. 1. pp. 117-127.
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abstract = "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.",
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