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Survival and quality of life outcome after mechanical ventilation in elderly stroke patients
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  1. C Foerch,
  2. K R Kessler,
  3. D A Steckel,
  4. H Steinmetz,
  5. M Sitzer
  1. Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
  1. Correspondence to:
 Dr C Foerch
 Department of Neurology, Johann Wolfgang Goethe-University, Schleusenweg 2-16, 60590 Frankfurt am Main, Germany; foerchem.uni-frankfurt.de

Abstract

Objectives: Mortality is high and functional outcome poor in mechanically ventilated stroke patients. In addition, age >65 years is an independent predictor of death at 2 months among these patients. Our objective was to determine survival rates, functional outcome, and quality of life (QoL) in stroke patients older than 65 years requiring mechanical ventilation.

Methods: A prospective cohort study with an additional cross-sectional survey in 65 patients aged 65 years and older (mean age (SD): 75.6 (6.0) years) with ischaemic or haemorrhagic stroke who underwent mechanical ventilation. Main outcome measures were survival rate at 6 months, and Barthel Index (BI), modified Rankin Scale, and QoL at 15.8 (SD 8.0) months.

Results: Survival rate at 6 months was 40%. Elective intubation (odds ratio (OR) 13.6; p = 0.002) was the only independent positive predictor for survival, while age >77.5 years (OR 0.1; p = 0.004) and white blood count >10/nl at admission (OR 0.31; p = 0.032) were independent negative predictors for survival at 6 months. At the time of the cross-sectional survey, BI was >70 in five out of 22 patients, 35–70 in three and <35 in the remaining 14 patients. QoL was impaired primarily in the physical domain, whereas the psychosocial domain was less affected.

Conclusions: Although only 40% of elderly patients intubated in the acute phase of stroke survived at least 6 months, one in four survivors recovered to a good functional outcome with a reasonable QoL. Elderly stroke patients need to be selected carefully for intensive care treatment, but elective intubation to allow diagnostic procedures should not be withheld primarily based on their age.

  • BI, Barthel Index
  • CI, confidence interval
  • MCA, middle cerebral artery
  • mRS, modified Rankin Scale
  • MV, mechanical ventilation
  • OR, odds ratio
  • QoL, quality of life
  • SIP, sickness impact profile
  • WBC, white blood count
  • intensive care therapy
  • outcome
  • quality of life
  • stroke
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Footnotes

  • Competing interests: none declared

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