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Early tracheostomy in patients undergoing mechanical thrombectomy for acute ischemic stroke.
Shah, Smit; Spirollari, Eris; Ng, Christina; Cordeiro, Kevin; Clare, Kevin; Nolan, Bridget; Naftchi, Alexandria F; Carpenter, Austin B; Dominguez, Jose F; Kaplan, Ian; Bass, Brittany; Harper, Emily; Rosenberg, Jon; Chandy, Dipak; Mayer, Stephan A; Prabhakaran, Kartik; Wang, Arthur; Gandhi, Chirag D; Al-Mufti, Fawaz.
Afiliação
  • Shah S; Department of Neurology, University of South Carolina/PRISMA Health Richland, Columbia, SC, United States of America.
  • Spirollari E; School of Medicine, New York Medical College, Valhalla, NY, United States of America.
  • Ng C; School of Medicine, New York Medical College, Valhalla, NY, United States of America.
  • Cordeiro K; University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
  • Clare K; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Nolan B; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Naftchi AF; School of Medicine, New York Medical College, Valhalla, NY, United States of America.
  • Carpenter AB; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Dominguez JF; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America. Electronic address: Jose.Dominguez@wmchealth.org.
  • Kaplan I; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Bass B; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Harper E; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Rosenberg J; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Chandy D; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Mayer SA; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Prabhakaran K; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Wang A; Department of Neurosurgery, Tulane University Medical Center, New Orleans, LA, United States of America.
  • Gandhi CD; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
  • Al-Mufti F; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America. Electronic address: Fawaz.Al-Mufti@wmchealth.org.
J Crit Care ; 78: 154357, 2023 12.
Article em En | MEDLINE | ID: mdl-37336143
ABSTRACT

PURPOSE:

Respiratory failure following mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is a known complication, and requirement of tracheostomy is associated with worse outcomes. Our objective is to evaluate characteristics associated with tracheostomy timing in AIS patients treated with MT.

METHODS:

The National Inpatient Sample was queried for adult patients treated with MT for AIS from 2016 to 2019. Baseline demographic characteristics, comorbidities, and inpatient outcomes were analyzed for associations in patients who received tracheostomy. Timing of early tracheostomy (ETR) was defined as placement before day 8 of hospital stay.

RESULTS:

Of 3505 AIS-MT patients who received tracheostomy, 915 (26.1%) underwent ETR. Patients who underwent ETR had shorter length of stay (LOS) (25.39 days vs 32.43 days, p < 0.001) and lower total hospital charges ($483,472.07 vs $612,362.86, p < 0.001). ETR did not confer a mortality benefit but was associated with less acute kidney injury (OR, 0.697; p = 0.013), pneumonia (OR, 0.449; p < 0.001), and sepsis (OR, 0.536; p = 0.002).

CONCLUSION:

An expected increase in complications and healthcare resource utilization is seen in AIS-MT patients receiving tracheostomy, likely reflecting the severity of patients' post-stroke neurologic injury. Among these high-risk patients, ETR was predictive of shorter LOS and fewer complications.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / AVC Isquêmico Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / AVC Isquêmico Idioma: En Ano de publicação: 2023 Tipo de documento: Article