Ventilation time and prognosis after stroke thrombectomy: the shorter, the better!

Abstract

Background We aimed to investigate the clinical impact of the duration of artificial ventilation in stroke patients receiving mechanical thrombectomy (MT) under general anesthesia. Methods All consecutive ischemic stroke patients who had been treated at our center with MT for anterior circulation large vessel occlusion under general anesthesia were identified over an eight‐year period. We analyzed ventilation time as a continuous variable and grouped patients into extubation within 6 hours ("early"), 6‐24 hours ("delayed") and >24 hours ("late"). Favorable outcome was defined as modified Rankin Scale scores of 0‐2 at three‐months post‐stroke. We also assessed pneumonia rate and reasons for prolonged ventilation. Results Among 447 MT patients (mean age 69.1±13.3 years, 50.1% female), median ventilation time was 3 hours. 188 (42.6%) patients had a favorable three‐months outcome, which correlated with shorter ventilation time (Spearman''s Rho=0.39, p<0.001). In patients extubated within 24 hours, early compared to delayed extubation was associated with improved outcome (odds ratio 2.40, 95% CI 1.53‐3.76, p<0.001). This was confirmed in multivariable analysis (p=0.01). Longer ventilation time was associated with a higher rate of pneumonia during neurointensive care unit/stroke unit stay (early/delayed/late extubation: 9.6%/20.6%/27.7%, p24 hours), delayed extubation (6‐24 hours) was associated with admission outside of core working hours (p<0.001). Conclusions Prolonged ventilation time after stroke thrombectomy independently predicts unfavorable outcome at three months and is associated with increased pneumonia rates. Therefore, extubation should be performed as early as safely possible.