Longitudinal Trajectories in Patients with Severe Acute Brain Injury Requiring Mechanical Ventilation: A Descriptive Analysis of a Single-Center Prospective Observational Cohort Study

Tuesday, October 31, 2023

4:05 PM – 4:11 PM

Location: Station 4

Presenting Author(s)

Natalie L. Smith

Medical Student
University of Washington
Seattle, Washington, United States

Non-presenting Author(s)

AJ

Adrienne James

Research Scientist
University of Washington Dept of Anesthesiology, United States
CF

Christine Fong

Research Scientist
University of Washington Dept of Anesthesiology, United States
NM

Nassim Matin, MD

Fellow
University of Washington Dept. of Neurology, United States
KS

Kasra Sarhadi, MD

Resident
University of Washington Dept. of Neurology, United States
JT

James Town, MD

Assistant Professor
3Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States
CC

Claire Creutzfeldt, MD

Associate Professor
University of Washington Dept. of Neurology, United States
CR

Chiara Robba, MD

Assistant Professor
Departments of Anesthesia and Intensive Care, Policlinico San Martino, United States
GC

Giuseppe Citerio, MD

Assistant Professor
4Departments of Anesthesia and Intensive Care, Policlinico San Martino, United States
AL

Abhijit Lele, MD

Professor
Departments of Anesthesiology and Neurosurgery, University of Washington, Seattle, WA, United States
SW

Sarah Wahlster, MD

Associate Professor
Department of Neurology, University of Washington, Seattle, WA, United States

Presenting Author(s)

NM

Nicole Mazwi, MD

Associate Professor
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States

Research Objectives: To describe longitudinal outcomes for patients with severe acute brain injury (SABI) who require mechanical ventilation (MV).

Design: Prospective Observational Cohort.

Setting: Neurocritical Care and Trauma Intensive Care Unit at Harborview Medical Center, a Level-1 Trauma and Comprehensive Stroke Center in Seattle, WA.

Participants: Consecutive patients over 18-years-old with SABI, including traumatic brain injury (TBI), spontaneous intracranial hemorrhage (sICH), acute ischemic stroke (AIS), and subarachnoid hemorrhage (SAH), who required MV on admission between September and November 2021.

Interventions: Not applicable.

Main Outcome Measures: Mortality in-hospital; Mortality and Glasgow Outcome Scale Extended (GOSE) score at 6-12 months follow-up.

Results: Overall, 103 patients (mean age 58, 72% male; 23% non-white, median Glasgow Coma Scale on admission 7; 49% TBI, 20% sICH, 19% AIS, 12% SAH) were included; 65% were insured through Medicare or Medicaid. Median duration of MV was 2 days (IQR 1,7.5), with 13% requiring MV for  24 hours (G1), 62% 1-7 days (G2), and 25% >7 days (G3). 13 patients underwent tracheostomy, all of whom were decannulated at follow-up. Overall mortality was 46% in-hospital and an additional 3% by follow-up (49% mortality total). Mortality distribution by SABI was 46% (TBI), 62% (sICH), 45% (AIS), 42% (SAH). Mortality by MV duration was 31% (GI), 52% (G2), 50% (G3). Sixty-seven percent of deaths occurred after withdrawal of life sustaining treatment (WLST). Patients were functionally independent (GOSE score 5-8) and residing at home at follow-up (median 7.2 months, IQR 5.0-8.6) for 81%/93% of TBI cohort, respectively; 38%/50% sICH; 56%/78% AIS; 83%/83% SAH; 86%/86% G1, 86%/79% G2, 42%/81% G3. Collection of GOSE scores at 18-24 months follow-up is in process.

Conclusions: Mortality was high for SABI patients who required MV and two third of in-hospital deaths were due to WLST. For survivors, 65% achieved functional independence and 82% were at home by 6-12 months following SABI, though outcomes varied by SABI mechanism and duration of MV.

Author(s) Disclosures: None

Learning Objectives:

Describe differences in functional outcome based on severe brain injury mechanism for a cohort of patients who required ventilation.
Describe differences over time in functional outcome for a cohort of patients who required ventilation who had acute brain injury.
Describe effects on mechanical ventilation duration on functional outcomes for a cohort of patients who required ventilation who had acute brain injury.