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Mortality Predictors in Stroke Patients Requiring Mechanical Ventilation: A Multicenter Prospective Observational
Vadim Ershov1,2, Andrey Belkin3,4, Vladimir Gorbachev5
1Orenburg State Medical University, Orenburg, Russia.
Journal of Intensive Care Medicine
|June 18, 2025
Summary
Predictors for mortality in severe stroke patients on mechanical ventilation were identified. Hypoxemia and hyperventilation increased risk, while pressure-controlled ventilation and ICP monitoring improved outcomes, aiding clinical decision-making.
Area of Science:
- Neurology
- Critical Care Medicine
- Respiratory Medicine
Background:
- Mechanical ventilation in acute severe stroke presents significant clinical challenges.
- Identifying mortality predictors is crucial for improving patient outcomes in this population.
Purpose of the Study:
- To assess the impact of various clinical factors on 28-day mortality in acute severe stroke patients requiring mechanical ventilation.
- To identify key predictors of mortality in this high-risk cohort.
Main Methods:
- Prospective, multicenter observational study involving 1144 patients across 14 hospitals in Russia.
- Inclusion criteria: confirmed cerebral stroke, age 18-90, requiring mechanical ventilation.
- Analysis of clinical factors, ventilation modes, and intracranial pressure (ICP) monitoring for impact on 28-day mortality.
Main Results:
- The 28-day mortality rate was 64.3%.
- Hypoxemia and hyperventilation mode were associated with increased mortality in patients with NIHSS > 20.
- Pressure-controlled ventilation and ICP monitoring were associated with decreased mortality.
- A non-linear relationship between NIHSS score and mortality was observed, with a trend emerging at 16 points.
Conclusions:
- Hypoxemia, hyperventilation, initial ventilation mode (VC vs. PC), and ICP monitoring methods are key predictors of mortality.
- These findings are essential for clinical decision-making in managing stroke patients requiring mechanical ventilation.
- Infectious complications correlated with longer mechanical ventilation and ICU stays.
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