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Clinical Impact of Ventilation Duration in Patients with Stroke Undergoing Interventional Treatment under General Anesthesia: The Shorter the Better?
- Source :
- AJNR Am J Neuroradiol
- Publication Year :
- 2016
- Publisher :
- American Society of Neuroradiology, 2016.
-
Abstract
- BACKGROUND AND PURPOSE: Whether general anesthesia for neurothrombectomy in patients with ischemic stroke has a negative impact on clinical outcome is currently under discussion. We investigated the impact of early extubation and ventilation duration in a cohort that underwent thrombectomy under general anesthesia. MATERIALS AND METHODS: We analyzed 103 consecutive patients from a prospective stroke registry. They met the following criteria: CTA-proved large-vessel occlusion in the anterior circulation, ASPECTS above 6 on presenting cranial CT, revascularization by thrombectomy with the patient under general anesthesia within 6 hours after onset of symptoms, and available functional outcome (mRS) 90 days after onset. RESULTS: The mean ventilation time was 128.07 ± 265.51 hours (median, 18.5 hours; range, 1–1244.7 hours). Prolonged ventilation was associated with pneumonia during hospitalization and unfavorable functional outcome (mRS ≥3) and death at follow-up (Mann-Whitney U test; P ≤ .001). According to receiver operating characteristic analysis, a cutoff after 24 hours predicted unfavorable functional outcome with a sensitivity and specificity of 60% and 78%, respectively. Our results imply that delayed extubation was not associated with a less favorable clinical outcome compared with immediate extubation after the procedure. CONCLUSIONS: Short ventilation times are associated with a lower pneumonia rate and more favorable clinical outcome. Cautious interpretation of our data implies that whether patients are extubated immediately after the procedure is irrelevant for clinical outcome as long as ventilation does not exceed 24 hours.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Airway Extubation
Anesthesia, General
Revascularization
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Occlusion
medicine
Humans
Radiology, Nuclear Medicine and imaging
030212 general & internal medicine
Prospective Studies
Registries
Prospective cohort study
Stroke
Aged
Thrombectomy
Interventional
Cerebral Revascularization
business.industry
Middle Aged
medicine.disease
Respiration, Artificial
Surgery
Pneumonia
Treatment Outcome
Anesthesia
Breathing
Female
Stents
Neurology (clinical)
business
Tomography, X-Ray Computed
030217 neurology & neurosurgery
Cohort study
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- AJNR Am J Neuroradiol
- Accession number :
- edsair.doi.dedup.....46e1901d181dc6b95986481adb11bf33