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- W2327283375 abstract "Introduction: Patients with spontaneous intracerebral hemorrhage (ICH) may require prolonged intubation for both ventilatory support and airway protection. Predicting need for and timing of tracheostomy may facilitate posthospital care and goals of care discussions with family. Hypothesis: We hypothesized that ICH Score, hydrocephalus (represented by external ventricular drain (EVD) use), and ICH location would be associated with tracheostomy in patients with ICH. Methods: We prospectively enrolled 249 patients admitted to a neurointensive care unit with ICH between 2007-2012, of whom 44 required tracheostomy. Patients were excluded if ICH was related to tumor, trauma, or vascular malformation. No specific ventilator weaning protocol was observed, and the primary physician and intensivist collaboratively determined the need for tracheostomy. Demographic and clinical data were collected throughout hospitalization, and outcome data were collected at 14 days, 28 days, and three months, including the modified Rankin Scale (mRS), a validated scale from 0 (no symptoms) to 6 (death). Results: Time from ICH symptom onset to tracheostomy was 8.0 (6.3-12.4) days. Admission GCS and ICH Score were associated with tracheostomy (p<0.001), and predicted fewer ventilator free days (p<0.001). Location of hematoma was associated with tracheostomy (p=0.007), as was placement of an external ventricular drain (OR=4.7, CI=2.4-9.2, P<0.001). In a multivariate logistic regression model, ICH score (OR 1.3 per ICH Score point, 95% CI 1.0-1.8, p=0.05), and EVD placement (OR 3.2, 95% CI 1.4-7.2, p=0.004) were associated with increased odds of tracheostomy after correction for hematoma location. Tracheostomy (OR=3.8, 95% CI=1.3-11.2, p=0.02) was associated with increased odds of death or dependence (mRS 4-6) at three months after correction for ICH Score (OR=2.9 per point, 95% CI=2.1-4.1, p<0.001). Conclusions: We found that higher ICH Score (severity) and EVD placement were associated with increased odds of tracheostomy. Tracheostomy was independently associated with poor outcome at 3 months, implying a worse potential for functional recovery. These data may be helpful for clarifying the prognosis in patients with acute ICH." @default.
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- W2327283375 date "2012-12-01" @default.
- W2327283375 modified "2023-09-25" @default.
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- W2327283375 doi "https://doi.org/10.1097/01.ccm.0000424888.09004.e0" @default.
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