Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2004 Jul;75(7):988–993. doi: 10.1136/jnnp.2003.021014

Survival and quality of life outcome after mechanical ventilation in elderly stroke patients

C Foerch 1, K Kessler 1, D Steckel 1, H Steinmetz 1, M Sitzer 1
PMCID: PMC1739125  PMID: 15201356

Abstract

Objectives: Mortality is high and functional outcome poor in mechanically ventilated stroke patients. In addition, age >65 years is an independent predictor of death at 2 months among these patients. Our objective was to determine survival rates, functional outcome, and quality of life (QoL) in stroke patients older than 65 years requiring mechanical ventilation.

Methods: A prospective cohort study with an additional cross-sectional survey in 65 patients aged 65 years and older (mean age (SD): 75.6 (6.0) years) with ischaemic or haemorrhagic stroke who underwent mechanical ventilation. Main outcome measures were survival rate at 6 months, and Barthel Index (BI), modified Rankin Scale, and QoL at 15.8 (SD 8.0) months.

Results: Survival rate at 6 months was 40%. Elective intubation (odds ratio (OR) 13.6; p = 0.002) was the only independent positive predictor for survival, while age >77.5 years (OR 0.1; p = 0.004) and white blood count >10/nl at admission (OR 0.31; p = 0.032) were independent negative predictors for survival at 6 months. At the time of the cross-sectional survey, BI was >70 in five out of 22 patients, 35–70 in three and <35 in the remaining 14 patients. QoL was impaired primarily in the physical domain, whereas the psychosocial domain was less affected.

Conclusions: Although only 40% of elderly patients intubated in the acute phase of stroke survived at least 6 months, one in four survivors recovered to a good functional outcome with a reasonable QoL. Elderly stroke patients need to be selected carefully for intensive care treatment, but elective intubation to allow diagnostic procedures should not be withheld primarily based on their age.

Full Text

The Full Text of this article is available as a PDF (162.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bergner M., Bobbitt R. A., Carter W. B., Gilson B. S. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. doi: 10.1097/00005650-198108000-00001. [DOI] [PubMed] [Google Scholar]
  2. Berrouschot J., Rössler A., Köster J., Schneider D. Mechanical ventilation in patients with hemispheric ischemic stroke. Crit Care Med. 2000 Aug;28(8):2956–2961. doi: 10.1097/00003246-200008000-00045. [DOI] [PubMed] [Google Scholar]
  3. Bonita R., Ford M. A., Stewart A. W. Predicting survival after stroke: a three-year follow-up. Stroke. 1988 Jun;19(6):669–673. doi: 10.1161/01.str.19.6.669. [DOI] [PubMed] [Google Scholar]
  4. Buck D., Jacoby A., Massey A., Ford G. Evaluation of measures used to assess quality of life after stroke. Stroke. 2000 Aug;31(8):2004–2010. doi: 10.1161/01.str.31.8.2004. [DOI] [PubMed] [Google Scholar]
  5. Burtin P., Bollaert P. E., Feldmann L., Nace L., Lelarge P., Bauer P., Larcan A. Prognosis of stroke patients undergoing mechanical ventilation. Intensive Care Med. 1994;20(1):32–36. doi: 10.1007/BF02425052. [DOI] [PubMed] [Google Scholar]
  6. Bushnell C. D., Phillips-Bute B. G., Laskowitz D. T., Lynch J. R., Chilukuri V., Borel C. O. Survival and outcome after endotracheal intubation for acute stroke. Neurology. 1999 Apr 22;52(7):1374–1381. doi: 10.1212/wnl.52.7.1374. [DOI] [PubMed] [Google Scholar]
  7. Cohen I. L., Lambrinos J., Fein I. A. Mechanical ventilation for the elderly patient in intensive care. Incremental changes and benefits. JAMA. 1993 Feb 24;269(8):1025–1029. [PubMed] [Google Scholar]
  8. Grotta J., Pasteur W., Khwaja G., Hamel T., Fisher M., Ramirez A. Elective intubation for neurologic deterioration after stroke. Neurology. 1995 Apr;45(4):640–644. doi: 10.1212/wnl.45.4.640. [DOI] [PubMed] [Google Scholar]
  9. Gujjar A. R., Deibert E., Manno E. M., Duff S., Diringer M. N. Mechanical ventilation for ischemic stroke and intracerebral hemorrhage: indications, timing, and outcome. Neurology. 1998 Aug;51(2):447–451. doi: 10.1212/wnl.51.2.447. [DOI] [PubMed] [Google Scholar]
  10. Hollander M., Koudstaal P. J., Bots M. L., Grobbee D. E., Hofman A., Breteler M. M. B. Incidence, risk, and case fatality of first ever stroke in the elderly population. The Rotterdam Study. J Neurol Neurosurg Psychiatry. 2003 Mar;74(3):317–321. doi: 10.1136/jnnp.74.3.317. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Howard G., Walker M. D., Becker C., Coull B., Feibel J., McLeroy K., Toole J. F., Yatsu F. Community Hospital-based Stroke Programs: North Carolina, Oregon, and New York. III. Factors influencing survival after stroke: proportional hazards analysis of 4219 patients. Stroke. 1986 Mar-Apr;17(2):294–299. doi: 10.1161/01.str.17.2.294. [DOI] [PubMed] [Google Scholar]
  12. Kessler S., Jaeckel W., Cziske R. Assessing health in musculoskeletal disorders--the appropriateness of a German version of the Sickness Impact Profile. Rheumatol Int. 1997;17(3):119–125. doi: 10.1007/s002960050020. [DOI] [PubMed] [Google Scholar]
  13. MAHONEY F. I., BARTHEL D. W. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61–65. [PubMed] [Google Scholar]
  14. Mayer S. A., Copeland D., Bernardini G. L., Boden-Albala B., Lennihan L., Kossoff S., Sacco R. L. Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke. 2000 Oct;31(10):2346–2353. doi: 10.1161/01.str.31.10.2346. [DOI] [PubMed] [Google Scholar]
  15. Narbone M. C., Rao R., Grugno R., Pellicanò M. A late 'migraine': the only symptom of an intrasellar aneurysm. Headache. 1997 Sep;37(8):527–528. doi: 10.1046/j.1526-4610.1997.3708527.x. [DOI] [PubMed] [Google Scholar]
  16. Rordorf G., Koroshetz W., Efird J. T., Cramer S. C. Predictors of mortality in stroke patients admitted to an intensive care unit. Crit Care Med. 2000 May;28(5):1301–1305. doi: 10.1097/00003246-200005000-00007. [DOI] [PubMed] [Google Scholar]
  17. Steiner T., Mendoza G., De Georgia M., Schellinger P., Holle R., Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke. 1997 Apr;28(4):711–715. doi: 10.1161/01.str.28.4.711. [DOI] [PubMed] [Google Scholar]
  18. Wijdicks E. F., Scott J. P. Causes and outcome of mechanical ventilation in patients with hemispheric ischemic stroke. Mayo Clin Proc. 1997 Mar;72(3):210–213. doi: 10.4065/72.3.210. [DOI] [PubMed] [Google Scholar]
  19. Wolfe C. D. A., Rudd A. G., Howard R., Coshall C., Stewart J., Lawrence E., Hajat C., Hillen T. Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register. J Neurol Neurosurg Psychiatry. 2002 Feb;72(2):211–216. doi: 10.1136/jnnp.72.2.211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. van Straten A., de Haan R. J., Limburg M., Schuling J., Bossuyt P. M., van den Bos G. A. A stroke-adapted 30-item version of the Sickness Impact Profile to assess quality of life (SA-SIP30). Stroke. 1997 Nov;28(11):2155–2161. doi: 10.1161/01.str.28.11.2155. [DOI] [PubMed] [Google Scholar]
  21. van Straten A., de Haan R. J., Limburg M., van den Bos G. A. Clinical meaning of the Stroke-Adapted Sickness Impact Profile-30 and the Sickness Impact Profile-136. Stroke. 2000 Nov;31(11):2610–2615. doi: 10.1161/01.str.31.11.2610. [DOI] [PubMed] [Google Scholar]
  22. van Swieten J. C., Koudstaal P. J., Visser M. C., Schouten H. J., van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988 May;19(5):604–607. doi: 10.1161/01.str.19.5.604. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES