Автор: Николай
создано: 17.01.2010 14:23
1.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. Survival and quality of life outcome after mechanical
ventilation in elderly stroke patients
C Foerch, K R Kessler, D A Steckel, H Steinmetz, M Sitzer
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J Neurol Neurosurg Psychiatry 2004;75:988–993.
2. Methods: A retrospective review of ISCH and HEM stroke patients who underwent MV at a
tertiary care academic center from 1994 to 1997 was performed to determine age, sex, type, and location of stroke (anterior
or posterior circulation); brainstem dysfunction at intubation (pupillary, corneal, and oculocephalic reflexes); indication for
intubation (neurologic deterioration, cardiopulmonary deterioration, or elective intubation for surgery); timing of intuba-
tion (on presentation or later); comorbidities; and outcome (hospital disposition). Results: A total of 230 patients, 74 with
ISCH and 156 with HEM (mean age, 61 i 16 years; male-to-female ratio, 1.15:1), underwent MV. Intubation rates were
6% for ISCH patients and 30% for HEM patients. Two-thirds of the patients required intubation on presentation (84%
were intubated for neurologic deterioration) and 131 patients (57%) died (ISCH, 55%; HEM, 58%). Signs of brainstem
dysfunction predicted a higher mortality for both groups. Additionally, early intubation and older age predicted mortality
for HEM, and male gender predicted mortality in ISCH. Stroke location and comorbidities did not influence outcome.
Conclusions: MV in acute stroke is associated with high mortality. Mortality and outcome were similar for ISCH and
HEM; however, the factors predictive of outcome may differ and influence decisions about the use of MV in such patients.
NEUROLOGY 1998;51:447-451
На мой взгляд переводить на ИВЛ этих больных надо. И не смотря на то, что прогноз у таких больных хуже, чем у тех кто не требует ИВЛ, он лучше чем без вентиляции.
Про стоимость и перспективы тоже достаточно понятно - очень дорого, качество жизни низкое, требуют хорошей соц. сети
Cost and Outcome of Mechanical Ventilation for
Life-Threatening Stroke
Stephan A. Mayer, MD; Daphne Copeland, MPH; Gary L. Bernardini, MD, PhD;
Bernadette Boden-Albala, MPH; Laura Lennihan, MD; Sharon Kossoff, MS; Ralph L. Sacco, MD, MS
Background and Purpose—Hospital mortality rates of 50% to 90% have been reported for stroke patients treated with
mechanical ventilation. These data have raised serious questions about the cost-effectiveness of this intervention. We
sought to determine how often stroke patients are mechanically ventilated, identify predictors of 30-day survival among
ventilated patients, and evaluate the cost-effectiveness of this intervention.
Methods—We identified mechanically ventilated patients in a population-based multiethnic cohort of 510 incidence stroke
patients who were hospitalized between July 1993 and June 1996. Factors affecting 30-day survival were identified in
a multiple logistic regression analysis. We calculated the cost per patient discharged alive, life-year saved, and
quality-adjusted life-year saved using a zero-cost, zero-life assumption.
Results—Ten percent of patients (n552) were mechanically ventilated. Thirty-day mortality was 65% overall and did not
differ significantly by stroke subtype. Glasgow Coma Scale score on the day of intubation (P,0.01) and subsequent
neurological deterioration (P50.02) were identified as predictors of 30-day mortality. The cost (1996 US dollars) of
hospitalization per patient discharged alive was $89 400; the cost per year of life saved was $37 600; and the cost per
quality-adjusted life-year saved was $174 200. Functional status of most survivors was poor; at 6 months, half were
severely disabled and completely dependent. In a worst-case scenario of quality of life preferences, mechanical
ventilation resulted in a net deficit of meaningful survival.
Conclusions—Two thirds of mechanically ventilated stroke patients die during their hospitalization, and most survivors are
severely disabled. Survival is particularly unlikely if patients are deeply comatose or clinically deteriorate after
intubation. In our multiethnic urban population, mechanical ventilation for stroke was relatively cost-effective for
extending life but not for preserving quality of life. (Stroke. 2000;31:2346-2353.)
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