A predictive analysis of the nonsurvivable patients with severe cerebral infarction after mechanical ventilation / 中国脑血管病杂志

ABSTRACT

Objective: To explore the predictors of the non-survivable patients with severe cerebral infarction after mechanical ventilation. Methods: The clinical data of 36 patients with acute cerebral infarction who had tracheal intubation were analyzed retrospectively. The patients were divided into survivor (n = 18) group and non-survivor group (n = 18) according to their prognosis. The observational endpoint was at day 60. Patients' Glasgow Coma Scale (GCS) score, respiratory function (blood gas pH value, oxygen partial pressure, carbon dioxide partial pressure, and oxygenation index), and the causes of death before tracheal intubation were documented. Results: The mortality at day 60 after mechanical ventilation was 50% in patients with severe cerebral infarction. The median GCS score was 3. 6 ± 1. 0 in the non-survivor group, and the median GCS score was 6.3 ± 1.2 in the survivor group before tracheal intubation. Oxygen partial pressure and oxygenation index presented to decrease in both groups before the tracheal intubation. The median oxygen partial pressure in the survivor and non-survivor groups were 69 ± 17 and 52 ± 7 mm Hg, respectively; and the oxygenation indexes were 170 ± 31 and 109 ± 34, respectively. The univariate analysis showed that the patients' GCS scores decreased before the tracheal intubation. The decrease of oxygen partial pressure and oxygenation index were the important factors for predicting mortality. The multivariate regression analysis showed that the patients' GCS score (P = 0.015) and oxygen partial pressure (P = 0.026) before the tracheal intubation were an independent factors for predicting the mortality in patients with cerebral infarction at day 60 after the mechanical ventilation. Conclusion: For patients with severe cerebral infarction, the mechanical ventilation support may contribute to decreasing the mortality, particularly in patients whose respiratory system complications have resulted in deterioration of the disease. The aggregate analysis has showed that the patients' severity of conscious disturbance and the oxygenation parameters before the tracheal intubation may contribute to predicting the prognosis.