Extubation after thrombectomy: the sooner, the better

Early extubation (within 6 hours) after thrombectomy independently predicts a favourable outcome at 3 months in stroke patients, compared to extubation between 6 and 24 hours [1]. Furthermore, pneumonia rates and duration of stay in the neurointensive care/stroke unit were reduced. Mechanical ventilation in these patients should therefore be shortened as much as safely possible.

In a single-centre study, researchers from the Medical University of Graz (Austria) aimed to assess the clinical impact of the duration of artificial ventilation in stroke patients receiving mechanical thrombectomy under general anaesthesia [1]. They identified all ischaemic stroke patients who had received mechanical thrombectomy for anterior circulation large vessel occlusion under general anaesthesia over a period of 8 years (n=447). Patients were divided into 3 groups, according to ventilation timing: “early” (extubation within 6 hours), “delayed” (6-24 hours), and “late” (>24 hours). The mean age was 69 years, half of patients were female; median ventilation time was 3 hours.

A favourable outcome, defined as modified Rankin Scale scores of 0-2 at 3-months post-stroke, was seen in 188 patients (42.6%) and correlated with shorter ventilation time (P<0.001). In patients extubated ≤24 hours, early extubation was associated with better outcomes than delayed extubation (OR 2.40; 95% CI 1.53-3.76; P<0.001), also in a multivariable analysis (P=0.007). The authors offered a number of possible explanations:

• higher rates of (ventilator-associated) pneumonia;
• impaired cerebral blood flow due possible vasodilatory effects of sedative drugs;
• hyperoxemia, which may occur in ventilated intensive care unit patients;
• delayed early rehabilitation and stroke work-up.

Of 65 patients with late extubation, the most frequent reasons for prolonged intubation were brain oedema (44.6%), impaired consciousness due to other reasons (26.1%), and respiratory insufficiency (15.9%). However, delayed extubations were predicted by non-medical reasons, notably admission outside of core working hours (P<0.001). During neurointensive care, longer ventilation time was strongly associated with a higher rate of pneumonia: 9.6%, 20.6%, and 27.7% in the early, delayed, and late group, respectively (P<0.01).

1. Fandler-Höfler S, et al. Abstract O3036, EAN 2020.

 



Posted on 9 September, 202028 October, 2020