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Outcome of Acute Brain Injury (ABI) Requiring Intubation and Mechanical Ventilation FREE TO VIEW

Qammar Abbas, MD; Viswanath Vasudevan, MD; Jose Contreras, MD; Pooja Vasudevan; Ameer Rasheed, MD
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The Brooklyn Hospital Center, Brooklyn, NY

Chest. 2013;144(4_MeetingAbstracts):880A. doi:10.1378/chest.1701670
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SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Patients with ABI require Intubation and mechanical ventilation(MV) for airway protection, and for passive hyperventilation to help reduce intracranial hypertension. We performed a retrospective study to delineate patient characteristics, ICU intensity of care and to assess both short and long term prognosis in terms survival to discharge of such patients.

METHODS: Analysis was made of 41 consecutive ABI patients who were admitted to ICU and received invasive mechanical ventilation over a one year period. We abstracted patient demographics, etiology of ABI, ICU length of stay, duration of MV, neurosurgical interventions , in-hospital mortality, Prolonged ventilator dependence, functional status, QOL and discharge locations. We categorized the brain injury as ischemic infarct, spontaneous intracerebral hemorrhage(ICH), traumatic sub dural hematoma(SDH), subarachnoid hemorrhage(SAH).

RESULTS: There were 25 males and 16 females with a median age of 58 yrs.( range 40-90). The cause of brain injury were: Ischemic infarct, 6; ICH, 27( cause: hypertension, 26: cocaine,1);SDH, 6; SAH, 2. Coma and inability to protect the airway was the indication in all. Passive hyperventilation was administered to 15 to reduce intracranial hypertension. 32 of 41 patients were medically managed, 3 with intraventricular bleed had ventriculostomy drain, 3 with ICH had evacuation of hematoma. 1 with SAH had clipping of aneurysm. The in-hospital mortality was 21. Of 20 survivors, 15 were successfully liberated from the ventilator. Tracheostomy was done in 7. 7 were in persistent vegetative state. 7 required arificial feeding. Duration of MV, median 3 days( range 1-15). LOS 10 days( range 1- 25 days) Five were discharged home, 3 to Nursing Home because of ADL dependence and 3 were sent for subacute rehabilitation, and 3 for acute in-patient rehabilitation.

CONCLUSIONS: Overall mortality of acutely brain injured patients who are mechanically ventilated is high. Most survivors were in persistent vegetative state and functionally dependent for ADL requiring artificial feeding. Though many survivors were ultimately liberated from ventilators, many required artifical airway. Spontaneous hypertensive intracerebral hemorrhage was the leading cause and only a minority of patients benefited with intensive care and neurosurgical inervention.

CLINICAL IMPLICATIONS: These patients have a high in hospital mortality. Survivors have poor functional status and impaired quality of life(QOL).

DISCLOSURE: The following authors have nothing to disclose: Qammar Abbas, Viswanath Vasudevan, Jose Contreras, Pooja Vasudevan, Ameer Rasheed

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