One-Year Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation
Romain Sonneville, Mikaël Mazighi, Magalie Collet, Étienne Gayat, Vincent Degos, Jacques Duranteau, Charles Grégoire, Tarek Sharshar, Giulia Naïm, David Cortier, Paul-Henri Jost, Arnaud Foucrier, François Bagate, Étienne de Montmollin, G. Papin, Éric Magalhaes, Bertrand Guidet, Omar Ben Hadj Salem, Sarah Benghanem, Loïc Le Guennec, Eric Delpierre, Stéphane Legriel, Bruno Mégarbane, Karim Toumert, Marc Tran, Guillaume Géri, Mehran Monchi, Eric Bodiguel, Éric Mariotte, Alexandre Demoule, Jonathan Zarka, Jean‐Luc Diehl, Damien Roux, Éric Barré, Sébastien Tanaka, David Osman, Pierre Pasquier, Fariza Lamara, Isabelle Crassard, Perrine Boursin, Stéphane Ruckly, Quentin Staiquly, Jean‐François Timsit, France Woimant, Tiare Ader, Hélène Bout, Damien Bresson, Alain Combes, Anne Chrisment, Sophie Crozier, Daniel Silva, Maxens Decavèle, Martin Dres, Frédéric Faugeras, Marie-Céline Fournier, Tobias Gauss, Coralie Gernez, Dominique Hurel, Matthieu Jamme, L. Josse, Igor Jurcisin, Lionel Kerhuel, Catherine Lamy, Aymeric Lancelot, Bertrand Lapergue, Christophe Lenclud, Mathilde Lermuzeaux, Isabelle Malissin, Alain Maldjian, Nathalie Marin, J.P. Martin, Thibault Martinez, Armand Mekontso Dessap, Hervé Outin, Claire Pichereau, Matthieu Pissot, Keyvan Razazi, Danielle Reuter, Christian Richard, Caroline Schimpf, Jérôme Servan, Laurie-Anne Thion, Widad Traki, Philippe Vassel, Bernard Vigué, Daniel Zafimahazo
Abstract
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.