CAUSES AND OUTCOME OF MECHANICAL VENTILATION IN PATIENTS WITH HEMISPHERIC ISCHEMIC STROKE

Objective: To attempt to determine factors that influence outcome in m echanically ventilated patients with ischemic hemispheric stroke, Mate rial and Methods: We reviewed data on 24 mechanically ventilated patie nts with an ischemic stroke in the territory of the middle cerebral ar tery, who had been admitted to a medical, neurologic, or neurosurgical intensive-care unit during the period between 1976 and 1994, Results: The circumstances surrounding mechanical ventilation were generalized tonic-clonic seizures or status epilepticus (N = 6), progression to s tupor and inability to protect the airway from brain smelling (N = 8), or-most commonly-bilateral pulmonary edema from congestive heart fail ure (N = 10), Of the 24 patients, 17 patients died (12 of neurologic c auses and 5 of cardiac arrest or cardiac arrhythmias), Of the seven su rviving patients, however, four with seizures and one with pulmonary e dema were functionally independent, Conclusion: Three clinical scenari os 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 isch emic hemispheric stroke and a subsequent need for mechanical ventilati on is poor; however, survival and independent function are possible if seizures or pulmonary edema prompt ventilatory support.