Abstract Details

Title Medical Comorbidities as Predictors of Mechanical Ventilation and Tracheostomy in Individuals with Large Hemispheric Infarctions

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 045

Objective Examine the relationship between medical comorbidities and requirement of mechanical ventilation (MV) in large hemispheric infarctions (LHI).

Background Patients with LHI often require MV. While there are multiple indications for intubation, the effects of comorbid medical conditions associated with increased risk of MV is less well studied.

Design/Methods Retrospective study of patients in the neurosciences intensive care unit at a tertiary care center with the diagnosis of acute ischemic stroke from 1/2012 to 12/2018. Inclusion criteria included infarct size >2/3 of the middle cerebral artery territory, with or without other vascular territory involvement. Demographic and clinical data were collected including presence of systolic heart failure (EF <40%), obesity (BMI >30), and smoking history. Fisher's exact test and logistic regression were used for association measures.

Results

Of the 2,318 patients screened, 380 met inclusion criteria, with MV required in 198 patients (52%) and tracheostomy in 38 patients (10%). MV group included 54% females; 52.7% in the non-MV group. Mean age of MV patients was 62.1 versus non-MV mean age was 66.3. Stroke laterality in MV group was 104 (52.5%) left hemisphere, 88 (44.5%) right hemisphere and 6 (3.0%) bilateral; in the non-MV group there were 80 (44.0%) left hemisphere, 99 (54.4%) right hemisphere and 3 (1.6%) bilateral. Regarding co-morbidities: mean BMI in MV group 29.7 versus 26.8 in non-MV; presence of systolic HF in 39 (22.3%) in the MV versus 29 (17.1%) in non-MV; smoking history in MV group with 99 (54.4%) people versus 95 (54.0%) of non-MV. These results were not statistically significant.

Conclusions There was no increased likelihood of requiring MV or tracheostomy in individuals presenting with LHI with systolic HF, obesity or smoking history. Higher BMI correlated with greater likelihood of MV (29.7 vs 26.8, p0.0001). Further research is needed to better identify stroke patients at risk for long term MV.

Authors/Disclosures
Andrea Sterenstein, MD (Rush University Medical Center) PRESENTER	Dr. Sterenstein has nothing to disclose.
Nandini Abburi, MD (Duke University Department of Neurology)	Dr. Abburi has nothing to disclose.
Hannah Breit, MD (University of Southern California)	Dr. Breit has nothing to disclose.
Sayona John, MD, FAAN (Rush University Medical Center)	Dr. John has nothing to disclose.
Sarah Song, MD, MPH, FAAN (Rush University Medical Center)	Dr. Song has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN.
Ivan Da Silva, MD	Dr. Da Silva has nothing to disclose.
Lauren Koffman, DO, MS (Temple University Hospital)	Dr. Koffman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Law Firm.

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