Prognostic factors of patients requiring ventilatory support in the neuro-intensive care unit

Abstract

Background and aim Among ICU admitted patients, primary indication for mechanical ventilation is neurologic in 20%. This is much higher in a dedicated neuro-ICU. The purpose of this study was to assess the clinical predictors for outcome of patients requiring ventilatory support in the neuro-ICU. Patients and methods This was a prospective cohort study done at Neuropsychiatry Department and Center of Psychiatry, Neurology and Neurosurgery, Tanta University, from May 2016 to May 2017. All patients requiring ventilatory support after admission in our ICU, who were more than or equal to 18 years, and did not die before mechanical ventilation introduction were considered for the study. Results Of 63 patients, 30 (47.6%) died after mechanical ventilation introduction. Analysis of variables showed that all the following were significant predictors for mortality: old age, Acute Physiology and Chronic Health Evaluation-II score on admission, maximum Sequential Organ Failure Assessment score, National Institutes of Health Stroke Scale, Intracerebral Hemorrhage score on admission, ventilation strategy, main cause for ventilation, stroke type, and association of hypertension and cardiac diseases. Main cause of ventilation also significantly influenced modified Rankin scale among survivors. Conclusion Old age is associated with higher mortality, although mechanical ventilation can influence mortality among younger age groups. Early introduction of noninvasive positive pressure ventilation can improve in-hospital mortality. Outcome of ventilated patients is closely related to the main cause of ventilation, indicating mechanical ventilation is not essentially a therapeutic measure, however, a crucial supportive one. Application of Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment scores and other prognostic and disability scores as National Institutes of Health Stroke Scale, Intracerebral Hemorrhage score and modified Rankin scale can monitor progression and significantly influence outcome of ventilated patients, especially when related to the main cause of ventilation.