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Intubation occurred 3 hours to 7 days(mean,41 hours)after the onset of symptoms;six of 20 patients required intubation within the first 6 hours. Once clinical deterioration began,10 of 20 patients required intubation within 1 hour.Six of 20 patients were discharged alive;two subsequently died,one is mostly dependent,two became mostly independent(one of these had a hemicraniectomy and is still improving,and the other died of an intercurrent illness 4 years after her stroke),and one is totally independent.The four"good"outcome survivors were distinguished by higher Glasgow Coma Scale scores(9.2 versus 5.9),and extubation was usually possible within 72 hours.For nonsurvivors,mean hospitalization after intubation was 6.4 days.In survivors,the monthly uninsured cost was$0 to$ 2,000,and caregivers experienced moderate stress.The same decision would be repeated by 76%of caregivers;53%of caregivers would want intubation for themselves.Conclusions:Satisfactory outcome is possible in the 8%of ischemic stroke patients requiring elective intubation.Possible predictors of good outcome include less severe depression of consciousness at the time of intubation,extubation within 3 days,and hemicraniectomy.In retrospect,most families would repeat the decision to intubate.Further study in more patients of the cost/benefit of cerebral resuscitation after stroke is greatly needed. |
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