Predictors of extubation success in acute ischemic stroke patients

• In this study of 112 intubated acute ischemic stroke patients we attempt to identify predictors of extubation success.
• Milder stroke severity and absence of dysarthria on presentation are independently associated with extubation success.
• Facial weakness, neglect, aphasia and development of pneumonia had no association with extubation success.
• respiratory parameters that guide extubation decisions were identical between the successful who failed extubation groups.
• The drivers behind extubation success in this patient population are neurologic rather than respiratory.

BackgroundAcute ischemic stroke (AIS) patients often undergo intubation and mechanical ventilation (MV). Prolonged intubation and MV have disadvantages and complications. Conventional extubation criteria based only on respiratory parameters are insufficient to guide extubation practices in stroke patients where capacity for airway protection is a major concern.ObjectiveTo identify clinical and neuroanatomical markers of successful extubation in AIS patients requiring MV.MethodsRetrospective review of tertiary care hospital patient database from May 2009–November 2012 to identify consecutive patients with AIS intubated during hospitalization. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness, facial weakness, dysarthria, neglect, infarct location, dysphagia, respiratory parameters and history of pneumonia on successful extubation by hospital discharge using multivariate logistic regression analysis.Results112 subjects met study criteria and were included in the analysis. Age and NIHSS scores (mean ± standard deviation) were 74.5 ± 16.1 years and 19 ± 9.8, respectively; 56% were women. In multivariate analysis, NIHSS score ≤ 15 (Odds Ratio 4.6, 95% Confidence Interval 1.9–11.3, p < 0.001) and absence of dysarthria prior to intubation (Odds Ratio 3.0, 95% Confidence interval 1.1–8.3, p = 0.04) were independently associated with successful extubation. Conventional respiratory parameters had no effect on extubation success in this cohort.ConclusionsMilder stroke and absence of dysarthria prior to intubation were independently associated with extubation success. Our findings could help inform extubation practices in patients with AIS though prospective validation is necessary.