Related Experiment Video
Updated: Jan 14, 2026
Modeling Stroke in Mice - Middle Cerebral Artery Occlusion with the Filament Model
Published on: January 6, 2011
Risk factors for prolonged mechanical ventilation in critically ill patients with ischemic stroke
Jielian Luo1, Chen Zhang2, Rou Deng1
1Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Abstract:
Prolonged mechanical ventilation (PMV) is associated with increased morbidity and mortality among critically ill patients with ischemic stroke, yet data on its risk factors remain limited. This study aimed to identify independent predictors of PMV in this population. Ischemic stroke patients were identified from the Medical Information Mart for Intensive Care IV database. PMV was defined as mechanical ventilation lasting more than 14 days. Multivariable logistic regression was used to identify factors associated with PMV. Model performance was assessed using receiver operating characteristic curves, calibration plots, and decision curve analysis. A total of 756 ischemic stroke patients were included, of whom 111 (14.7 %) required PMV. In-hospital and one-year mortality rates in the PMV group were 27.0 % and 45.9 % respectively. Independent risk factors for PMV included BMI ≥33 kg/m2 (OR 1.82, 95 % CI 1.10-3.02), COPD (OR 2.02, 95 % CI 1.25-3.24), pH ≥ 7.45 (OR 1.79, 95 % CI 1.12-2.86), respiratory rate ≥20 min-1 (OR 2.39, 95 % CI 1.47-3.88), sepsis onset before D14 (OR 8.48, 95 % CI 1.75-41.06), tracheostomy (OR 7.38, 95 % CI 4.38-12.44), vasopressor (OR 2.19, 95 % CI 1.26-3.79) and pneumonia onset before D14 (OR 1.68, 95 % CI 1.01-2.79). These variables were incorporated into a nomogram, which demonstrated good discrimination (AUC 0.86, 95 % CI 0.83-0.89) and calibration (Hosmer-Lemeshow P = 0.149). In conclusion, PMV in critically ill ischemic stroke patients is associated with COPD, sepsis, obesity, alkalosis, increased respiratory rate, tracheostomy, vasopressor use, and pneumonia. The predictive model incorporating these factors showed good diagnostic performance and may aid early risk stratification and management.
Insights
Prolonged mechanical ventilation (PMV) in ischemic stroke patients is linked to conditions like COPD, sepsis, and obesity. Identifying these risk factors can help predict and manage PMV, improving patient outcomes.
Area of Science:
- Critical Care Medicine
- Neurology
- Pulmonology
Background:
- Prolonged mechanical ventilation (PMV) increases morbidity and mortality in critically ill ischemic stroke patients.
- Limited data exists on the independent risk factors for PMV in this specific patient population.
Purpose of the Study:
- To identify independent predictors of PMV in critically ill ischemic stroke patients.
- To develop a predictive model for early risk stratification and management of PMV.
Main Methods:
- Utilized the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to identify ischemic stroke patients.
- Defined PMV as mechanical ventilation exceeding 14 days.
- Employed multivariable logistic regression and assessed model performance using ROC curves, calibration plots, and decision curve analysis.
Main Results:
- 14.7% of 756 ischemic stroke patients required PMV, with higher in-hospital (27.0%) and one-year (45.9%) mortality.
- Independent risk factors for PMV included obesity (BMI ≥33 kg/m²), COPD, alkalosis (pH ≥7.45), elevated respiratory rate (≥20 min⁻¹), sepsis onset before day 14, tracheostomy, vasopressor use, and pneumonia onset before day 14.
- A developed nomogram showed good discrimination (AUC 0.86) and calibration.
Conclusions:
- PMV in critically ill ischemic stroke patients is associated with several clinical factors including COPD, sepsis, obesity, alkalosis, increased respiratory rate, tracheostomy, vasopressor use, and pneumonia.
- The predictive model demonstrates strong diagnostic performance, potentially aiding in early risk assessment and clinical management strategies.
