Causes and outcome of mechanical ventilation in patients with hemispheric ischemic stroke

To attempt to determine factors that influence outcome in mechanically ventilated patients with ischemic hemispheric stroke.

We reviewed data on 24 mechanically ventilated patients with an ischemic stroke in the territory of the middle cerebral artery, who had been admitted to a medical, neurologic, or neurosurgical intensive-care unit during the period between 1976 and 1994.

The circumstances surrounding mechanical ventilation were generalized tonic-clonic seizures or status epilepticus (N = 6), progression to stupor and inability to protect the airway from brain swelling (N = 8), or--most commonly--bilateral pulmonary edema from congestive heart failure (N = 10). Of the 24 patients, 17 patients died (12 of neurologic causes and 5 of cardiac arrest or cardiac arrhythmias). Of the seven surviving patients, however, four with seizures and one with pulmonary edema were functionally independent.

Three clinical scenarios generally underlie mechanical ventilation in patients with ischemic hemispheric stroke (generalized tonic-clonic seizures, brain swelling, and bilateral pulmonary edema). The outcome in patients with an ischemic hemispheric stroke and a subsequent need for mechanical ventilation is poor; however, survival and independent function are possible if seizures or pulmonary edema prompt ventilatory support.