Figure 1 is the flow chart. Table 1 reports the main features of the 323 included patients; among them, 61(18.9%) were considered too sick to benefit from life-sustaining therapies but were admitted to the ICU as potential organ donors.
Study flowchart. ICU, intensive care unit; mRS, modified Rankin Scale; SAH, subarachnoid hemorrhage; SDH: subdural hemorrhage
ICU Management and Outcomes
Table 2 reports the treatments and complications. Of the 257 patients who required endotracheal intubation, 252 (98%) were intubated on the first ICU day. Acute-phase stroke therapy was given to 81 (25.1%) patients, including 61 (75.3%) with intracerebral hemorrhage and 20 (24.7%) with ischemic stroke. Seven (2.2%) patients developed acute respiratory distress syndrome (ARDS) and 5 (1.5%) septic shock. Stroke-related complications developed during the ICU stay in 214 (66.3%) patients, the most common being intracranial hypertension and hydrocephalus. In the 124 patients with decisions to limit life-sustaining treatments, the median time from ICU admission to the decision was 3[1–8] days. Hospital mortality was 87.1% in patients with and 45.2% in patients without treatment-limitation decisions.
Figure 2 shows the mRS scores 28 days and 6 months after ICU admission. On day 28, the mRS was 0–2 in 23 (7.7%) patients, 3–5 in 79 (26.7%) patients, and 6 in 195 (65.6%) patients; the mRS score was missing for 26 patients. At month 6, the mRS was 0–2 in 61 (19.5%) patients, 3–5 in 50 (16.0%) patients, and 6 in 202 (64.5%) patients; the mRS score was missing for 10 patients. The corresponding proportions were 24.1, 19.7, and 56.1%, respectively, in the 252 patients not admitted to the ICU as potential organ donors. Of the 189 patients with no treatment-limitation decisions taken in the ICU, 58 (30.5%), 40 (21%), and 92 (48.5%) had mRS scores of 0–2, 3–5, and 6, respectively, 6 months after ICU admission.
Neurological outcome assessed using the modified Rankin Scale score (mRS) 28 days and 6 months after ICU admission. Missing data: n = 26 (8%) on day 28 and n = 10 (3.1%) at month 6
Factors Associated With the 6-month Modified Rankin Scale Score (mRS)
By univariate analysis, variables assessed at ICU admission and associated with a mRS score of 0–2 at 6 months were higher GCS score, persistent pupillary light reflex, higher body temperature, and acute-phase stroke therapy. In contrast, older age, hemorrhagic (versus ischemic) stroke, mechanical ventilation, and greater acute-illness severity (higher SAPSII) were associated with a higher risk of disability or death. Multivariable analysis identified only two independent predictors: older age was negatively associated, and higher GCS score positively associated, with having a mRS between 0 and 2 at 6 months (Table 3 and Figure 3).
Proportion of patients with a favorable neurological outcome at month 6 according to age and Glasgow Coma Scale score. Favorable neurological outcome was defined as a modified Rankin Scale (mRS) score of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability). mRS, modified Rankin Scale score; SAH: subarachnoid hemorrhage; SDH: subdural hematoma; ICU: intensive care unit
BMC Anesthesiol. 2022;22(235) © 2022 BioMed Central, Ltd.