Abstract Details

Title Clinical Trajectories in Patients with Severe Acute Brain Injury Requiring Mechanical Ventilation: A Descriptive Analysis of a Single-Center Prospective Observational Cohort Study

Topic Neuro Trauma and Critical Care

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-005

Objective To describe outcomes for patients with severe acute brain injury (SABI) who require mechanical ventilation (MV).

Background Patients with SABI often require MV due to impaired consciousness and insufficient airway protection, reflecting a substantial neurological injury. Outcomes for this high-acuity population have been insufficiently explored.

Design/Methods In this single-center prospective, observational cohort study at a level-1 trauma and comprehensive stroke center, we included consecutive adult patients with SABI, including traumatic brain injury (TBI), spontaneous intracranial hemorrhage (sICH), acute ischemic stroke (AIS), and subarachnoid hemorrhage (SAH), who required MV on admission between September-November 2021. We assessed in-hospital and 6-12 months mortality, tracheostomy and percutaneous gastrostomy tube (PEG) placement, and Extended Glasgow Outcome Score (GOS-E) at 6-12 months.

Results Overall, 90 patients (age 55 [SD 19], 73% male; median Glasgow Coma Scale on admission 7 [IQR 3,11]; 50% TBI, 20% sICH, 18% AIS, 12% SAH) were included. Median duration of MV was 2 days (IQR 1,7), with 40% requiring MV for £ 24 hours (G1), 37% 1-7 days (G2), and 23% >7 days (G3). In-hospital mortality was 47% (n=42), 79% (33/42) died after withdrawal of life-sustaining treatments (30% £24 hours, 24% 1-7 days, 45% >7 days). One third of survivors (30%, n=13) underwent PEG, 16% (n=7) tracheostomy. At 6-12 months, 51% (n=46) had died (51% TBI, 67% sICH, 44% AIS, 36% SAH; 44% G1, 55% G2, 57% G3); 57% of survivors (64% TBI, 50% sICH, 33% AIS, 71% SAH; 60% G1, 67% G2, 22% G3) had a GOS-E of 5-8. Among survivors who underwent PEG and tracheostomy, 54% and 29% had a GOS-E 5-8; all survivors who initially underwent tracheostomy were decannulated at 6-12 months.

Conclusions Mortality and long-term disability in patients with SABI who required MV were high and varied based on SABI subtype and duration of MV.

Authors/Disclosures
Natalie Smith, MD PRESENTER	Ms. Smith has nothing to disclose.
	No disclosure on file
Nassim Matin, MD (Barrow Neurological Institute)	Dr. Matin has nothing to disclose.
Kasra Sarhadi, MD	Dr. Sarhadi has nothing to disclose.
	No disclosure on file
Claire Creutzfeldt, MD	The institution of Dr. Creutzfeldt has received research support from NINR. The institution of Dr. Creutzfeldt has received research support from NIA.
	No disclosure on file
	No disclosure on file
Abhijit Lele	Abhijit Lele has received personal compensation for serving as an employee of LifeCenter Northwest .
Sarah Wahlster, MD	Dr. Wahlster has nothing to disclose.

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