Ischemic strokes requiring mechanical ventilation in the Intensive Care Unit

OBJECTIVE: To describe the clinical profile and the outcome of patients with clinical diagnosis of ischemic stroke requiring mechanical ventilation at King Fahd Hospital of the University.

METHODS: A descriptive study of all cases of ischemic stroke patients requiring mechanical ventilation admitted to the Intensive Care Unit at King Fahd Hospital of the University, Saudi Arabia, between August 1996 - August 1998 with their clinical pattern and outcome.

RESULTS: A total of 25 stroke patients with female to male ratio of 1.7:1 and mean age of 61.2+/-2.6 years. The vascular territories were middle cerebral artery 60% of the case, 20% basilar and 20% multiple territories. Hypertension (80%), diabetes mellitus (72%), hyperlipidemia (36%), hyperglycemia (32%) and obesity (16%) were the common risk factors. Glasgow Coma Scale on admission and 24 hours later were reported. The computerized tomography of the head shows ischemic strokes in the following distribution: Middle cerebral artery 48%, basilar 20% and mixed territories 32%. Of the twenty-five patients in the Intensive Care Unit, 14 patients (56%) showed improvement, 2 patients (8%) unchanged, and 9 patients (36%) died. Age, absence of corneal reflexes, presence of multiple infarcts on computerized tomography of the head and systemic complication of heart failure, hyperosmolar and pneumonia are associated features indicating poor outcome.

CONCLUSION: The risk factors, predictors and poor outcome are similar with those reported in the literature. The outcome of stroke with mechanically ventilated patients, in the opinion of the author, calls for a need of specialized stroke team and the establishment of a Neuro-Intensive Care Unit, which will help in optimizing treatment strategies and appropriately allocate resources.