Clinical predictors and outcome of patients of acute stroke requiring ventilatory support: A prospective hospital based cohort study

The purpose of this study was to identify clinical factors which may help in predicting the requirement of support of mechanical ventilation (MV) in patients with stroke. This was a prospective cohort study done at a tertiary referral center of India, from December 2008 to December 2009. All consecutive patients of acute stroke, who were admitted from emergency or through outpatient department, and were ≥ 18 years and in whom written consent was available, were considered for the study. Of 193 patients included in the study, 60 (31.08%) patients were intubated due to various reasons. Multivariate analysis of statistically significant and most clinically important variables showed that overall predictor accuracy of requirement of mechanical ventilation is 88% if patients had history of progression of symptoms (OR = 10.38; p < 0.001), loss of consciousness at the time of onset (OR = 3.18; p = 0.011) and GCS motor score ≤ 5 (p < OR = 34.62; 0.001). The findings of this study suggest that factors including the presence of poor sensorium, the progression of symptom and low motor GCS are independent predictors of requirement of mechanical ventilation in patients with stroke and appropriate and cautious timely use of MV can help in improving mortality and morbidity from stroke.