Evaluation of Risk Factors for Invasive Mechanical Ventilation Requirement in Posterior Circulation Stroke

Abstract

Ischaemic stroke is recognised as one of the common causes of disability and death today, and it is a primary reason for admission to intensive care units. Posterior circulation strokes account for 20-25% of ischaemic strokes. Respiratory failure is among the leading causes of mortality. Identifying risk factors may aid in taking preventive measures. This study aims to identify the risk factors associated with invasive mechanical ventilation in patients with posterior circulation stroke. This study included patients diagnosed with posterior circulation stroke by the Neurology Clinic at our tertiary centre between 01.01.2019 and 01.01.2021. It was designed to compare patients who required invasive mechanical ventilation with those who did not, and to identify associated risk factors. Independent risk factors for requiring invasive mechanical ventilation in patients with posterior circulation infarcts were found to be stroke-related pneumonia, basilar artery occlusion, and ischaemic stroke due to large artery disease. SOFA and APACHE II scores, along with 28-day mortality rates, were assessed in patients requiring invasive mechanical ventilation. 28-day mortality occurred in 6 patients. The mean SOFA score was 4.72 ± 2.72, and the mean APACHE II score was 19.88 ± 5.34. In this study, the need for invasive mechanical ventilation in posterior circulation strokes was associated with basilar artery occlusion, stroke aetiology being large artery atherosclerosis, presence of stroke-related pneumonia. The main limitation of this study is its retrospective design, and as it was conducted at a single centre, it may not reflect the wider population. Multicentre and prospective studies are necessary to address this issue.

Keywords

• Posterior circulation stroke
• Respiratory failure
• Mechanical ventilation

Posterior Dolaşım İnfezyonunda İnvaziv Mekanik Ventilasyon Gereksiniminin Risk Faktörlerinin Değerlendirilmesi

Abstract

İskemik inme günümüzde yaygın sakatlık ve ölüm nedenlerinden biri olarak kabul edilmekte ve yoğun bakım ünitelerine yatışın birincil nedenidir. Posterior sirkülasyon inmesi, iskemik inmelerin %20-25'ini oluşturur. Solunum yetmezliği önde gelen mortalite nedenleri arasındadır. Risk faktörlerinin belirlenmesi koruyucu önlemlerin alınmasına yardımcı olabilir. Bu çalışma, posterior sirkülasyon inmesinde invaziv mekanik ventilasyon için risk faktörlerini belirlemeyi amaçlamaktadır. Bu çalışmaya, 01.01.2019-01.01.2021 tarihleri arasında üçüncü basamak merkezimiz Nöroloji Kliniği tarafından posterior sirkülasyon inmesi tanısı konulan hastalar dahil edilmiştir. İnvaziv mekanik ventilasyon gerektiren ve gerektirmeyen hastaları karşılaştırmak ve ilişkili risk faktörlerini belirlemek amacıyla tasarlanmıştır. Posterior sirkülasyon infarktüsü olan hastalarda invaziv mekanik ventilasyon gereksinimi için bağımsız risk faktörlerinin inme ilişkili pnömoni, baziler arter tıkanıklığı ve büyük arter hastalığına bağlı iskemik inme olduğu bulunmuştur. İnvaziv mekanik ventilasyon gerektiren hastalarda SOFA ve APACHE II skorları ile 28 günlük mortalite oranları değerlendirilmiştir. 28 günlük mortalite 6 hastada görüldü. Ortalama SOFA skoru 4,72 ± 2,72, ortalama APACHE II skoru ise 19,88 ± 5,34 olarak bulundu. Bu çalışmada, posterior sirkülasyon inmelerinde invaziv mekanik ventilasyon ihtiyacı, inme etyolojisi büyük arter aterosklerozu olan baziler arter oklüzyonu ve inme ilişkili pnömoni varlığı ile ilişkilendirildi. Bu çalışmanın temel sınırlaması retrospektif tasarımıdır ve tek bir merkezde yürütüldüğü için daha geniş popülasyonu yansıtmayabilir. Bu konuyu ele almak için çok merkezli ve prospektif çalışmalara ihtiyaç vardır.

Keywords

• posterior sirkülasyon inmesi
• solunum yetmezliği
• mekanik ventilasyon

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