Abstract
Introduction. Stroke patients often meet respiratory guidelines for extubation, but uncertainty exists if patients will protect their airway due to impaired mental status. Patients with middle cerebral artery (MCA) acute ischemic stroke (AIS) might have specific predictors of successful extubation. Methods. Retrospective cohort of MCA AIS patients requiring intubation. Results. Thirty-seven MCA AIS patients were extubated successfully and ten failed extubation. Those who successfully extubated had higher extubation composite and eye response Glasgow Coma Scale (GCS) scores compared to those who failed (median 10T (IQR 9T–11T) versus 9.5T (8T–10T), P = 0.047, and 4 (3-4) versus 2.5 (1–3), P < 0.01). When adjusted for age, admission National Institutes of Health Stroke Scale score and laterality, patients with a GCS score ≥8T trended toward extubating successfully (OR 23.30 (CI 0.94–580.27), P = 0.055). Conclusions. The GCS score might be important in predicting successful extubation in MCA AIS patients. Further prospective study is warranted to better assess factors predictive of extubation outcome in stroke and other brain-injured patients.
Highlights
Stroke patients often meet respiratory guidelines for extubation, but uncertainty exists if patients will protect their airway due to impaired mental status
Our findings exhibit the use of the composite Glasgow Coma Scale (GCS) score as a possible important predictor for successful extubation in middle cerebral artery (MCA) acute ischemic stroke (AIS) patients
A higher GCS score previously has been shown to be a predictor for successful extubation in critically ill patients [5, 10], and daily screening for extubation readiness including a criterion for GCS ≥8 might be a better predictor for successful extubation in neurologic patients than physician judgment alone [9]
Summary
Stroke patients often meet respiratory guidelines for extubation, but uncertainty exists if patients will protect their airway due to impaired mental status. Patients with middle cerebral artery (MCA) acute ischemic stroke (AIS) might have specific predictors of successful extubation. The GCS score might be important in predicting successful extubation in MCA AIS patients. Once a stroke patient is mechanically ventilated, respiratory parameters guide the physician in determining when to discontinue mechanical ventilation and airway protection. Stroke and other brain-injured patients often meet respiratory guidelines for extubation, but the physician is uncertain if due to impaired mental status, a patient will be unable to protect his or her airway [6]. Respiratory weaning parameters within current guidelines are not predictive of extubation failure in neurocritical care patients intubated solely for neurologic reasons [7]. Given the limited data available to predict extubation success in critically ill neurologic patients, we hypothesized that patients with middle cerebral artery
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