Clinical Impact of Ventilation Duration in Patients with Stroke Undergoing Interventional Treatment under General Anesthesia: The Shorter the Better?

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.

© 2016 by American Journal of Neuroradiology.

Figures

Fig 1.

Boxplots illustrating the association between outcome measures and ventilation times. Clinical measures (mRS and death) as assessed after 90 days.

Fig 2.

Cox regression showing the cumulative hazard for pneumonia during hospitalization and unfavorable clinical outcome (mRS ≥3 and death assessed after 90 days), depending on ventilation duration.

Fig 3.

Odds ratios for pneumonia during hospitalization and unfavorable clinical outcome (mRS ≥3 and death assessed after 90 days), depending on whether extubation was performed immediately after the procedure or within time windows of 6, 12, 18.5, 24, 48, 72, 96 hours, and 1 week.