Abstract T P397: Predictors Of Extubation Success In Acute Ischemic Stroke Patients

Abstract

Background: Acute ischemic stroke (AIS) often necessitate intubation and mechanical ventilation (MV) for reasons unique to this patient population. Prolonged intubation and MV have several disadvantages. Conventional extubation criteria focused on respiratory parameters are insufficient to guide extubation in these patients. . Objective: To identify relevant clinical and neuroanatomical markers of successful extubation in AIS patients requiring mechanical ventilation. Methods: We retrospectively reviewed our patient database from 2007-2012 to identify consecutive patients admitted with AIS who were intubated during hospitalization. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness, facial weakness, dysarthria, neglect, infarct location (right-, left-, bi-hemispheric and brainstem), dysphagia, and history of pneumonia on successful extubation by hospital discharge in a logistic regression analysis. Results: 112 subjects were included in the analysis. The median age and NIHSS scores (median ± standard deviation) were 74.5 ± 16.1 years and 19 ± 9.8, respectively; 56 % were women (table). In a multivariate analysis, NIHSS score ≤ 15 (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.8-8.9; p <0.007) and absence of dysarthria prior to intubation (odds ratio [OR] 2.9; 95% confidence interval [CI] 1.17-7.0; P < .02) were significant predictors of successful extubation. The c-statistic for the model was 0.754 indicating good discrimination. Discussion: Milder stroke deficit as defined by NIHSS and absence of dysarthria prior to intubation were found to be independent predictors of extubation success. Dysarthria probably constitutes a surrogate of buccopharyngeal musculature integrity and patients’ ability to handle oral secretions. Our findings could help inform extubation practices in patients with AIS though they merit prospective validation.