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Functional, cognitive and emotional long–term outcome of patients with ischemic stroke requiring mechanical ventilation

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Abstract

Prognosis of patients with ischemic stroke requiring mechanical ventilation (MV) has been reported to be poor. However, longterm survival and functional outcome have scarcely been studied and nothing is known about the prevalence of cognitive impairment or depression in survivors and their quality of life (QoL).

We identified all patients treated for acute ischemic stroke on a Neurological Intensive Care Unit during 3.5 years who required MV for more than 24 hours. Early mortality rate at 2 months and survival rates at 1 and 2 years were determined. Survivors were examined for functional outcome (modified Rankin Scale (mRS), Barthel Index), cognitive impairment (Mini Mental State Examination (MMSE)), depression (Beck Depression Inventory, BDI) and QoL (Short Form–36). Clinical characteristics on admission were analyzed for prognostic significance. Of 101 consecutive patients, 44% died within 60 days. Survival rates at 1 and 2 years were 40% and 33%, respectively.Age > 60 years (p = 0.002) and Glasgow Coma Scale score < 10 on admission (p = 0.002) were independent predictors of early and late mortality. History of myocardial infarction (p = 0.007) independently predicted late mortality at 2 years. Of 33 surviving patients, nine (27%) had a good functional outcome (mRS 0–2). Of 27 survivors who could be interviewed, 17 (63%) had no cognitive impairment (MMSE > 24) and 20 (74%) did not suffer from relevant depression (BDI < 19).

In conclusion, longer–term survival of patients with ischemic stroke requiring MV was 33% and every fourth survivor resumed an independent life without dementia or depression. Older patients comatose on admission and with concomitant cardiovascular disease had the lowest probability of a favorable outcome.

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Authors and Affiliations

  1. Klinik für Neurologie, Vivantes Auguste-Viktoria-Klinikum, Rubensstraße 125, 12157, Berlin, Germany

    Eva Schielke

  2. Dept. of Neurology, Charité Hospital, Humboldt-University Berlin, Schumannstr. 20/21, 10117, Berlin, Germany

    Markus A. Busch MD, Thomas Hildenhagen MD, Martin Holtkamp MD, Lutz Harms MD & Florian Masuhr MD

  3. Institute of Medical Biometry Charité, Spandauer Damm 130, 14050, Berlin, Germany

    Ingeborg Küchler PhD

Authors
  1. Eva Schielke
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  2. Markus A. Busch MD
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  3. Thomas Hildenhagen MD
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  4. Martin Holtkamp MD
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  5. Ingeborg Küchler PhD
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  6. Lutz Harms MD
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  7. Florian Masuhr MD
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Correspondence to Eva Schielke.

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Drs. Schielke and Busch contributed equally to the study.

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Schielke, E., Busch, M.A., Hildenhagen, T. et al. Functional, cognitive and emotional long–term outcome of patients with ischemic stroke requiring mechanical ventilation. J Neurol 252, 648–654 (2005). https://doi.org/10.1007/s00415-005-0711-5

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  • DOI: https://doi.org/10.1007/s00415-005-0711-5

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