Causes and outcome of mechanical ventilation in patients with hemispheric ischemic stroke.

Abstract

OBJECTIVE: To attempt to determine factors that influence outcome in mechanically ventilated patients with ischemic hemispheric stroke. MATERIAL AND METHODS: We reviewed data on 24 mechanically ventilated patients with an ischemic stroke in the territory of the middle cerebral artery, who had been admitted to a medical, neurologic, or neurosurgical intensive-care unit during the period between 1976 and 1994. RESULTS: The circumstances surrounding mechanical ventilation were generalized tonic-clonic seizures or status epilepticus (N = 6), progression to stupor and inability to protect the airway from brain swelling (N = 8), or--most commonly--bilateral pulmonary edema from congestive heart failure (N = 10). Of the 24 patients, 17 patients died (12 of neurologic causes and 5 of cardiac arrest or cardiac arrhythmias). Of the seven surviving patients, however, four with seizures and one with pulmonary edema were functionally independent. CONCLUSION: Three clinical scenarios generally underlie mechanical ventilation in patients with ischemic hemispheric stroke (generalized tonic-clonic seizures, brain swelling, and bilateral pulmonary edema). The outcome in patients with an ischemic hemispheric stroke and a subsequent need for mechanical ventilation is poor; however, survival and independent function are possible if seizures or pulmonary edema prompt ventilatory support.