Life Support Limitations in Mechanically Ventilated Stroke Patients

Objectives:. The determinants of decisions to limit life support (withholding or withdrawal) in ventilated stroke patients have been evaluated mainly for patients with intracranial hemorrhages. We aimed to evaluate the frequency of life support limitations in ventilated ischemic and hemorrhagic stro...

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Autores principales:	Etienne de Montmollin, MD, PhD, Carole Schwebel, MD, PhD, Claire Dupuis, MD, PhD, Maité Garrouste-Orgeas, MD, Daniel da Silva, MD, Elie Azoulay, MD, PhD, Virginie Laurent, MD, Guillaume Thiéry, MD, PhD, Alexandra Grinea, MD, Guillaume Marcotte, MD, Johanna Oziel, MD, Marc Gainnier, MD, Shidasp Siami, MD, PhD, Jean Reignier, MD, PhD, Benjamin Sztrymf, MD, PhD, Christophe Adrie, MD, Stephane Ruckly, MSc, Romain Sonneville, MD, PhD, Jean-François Timsit, MD, PhD, on behalf of the OUTCOMEREA Study Group, Jean-François Timsit, Elie Azoulay, Jean-Ralph Zahar, Bruno Mourvillier, Michael Darmon, Jean-Francois Timsit, Corinne Albert, Stephane Ruckly, Sébastien Bailly, Aurélien Vannieuwenhuyze, Christophe Adrie, Carole Agasse, Bernard Allaouchiche, Olivier Andremont, Pascal Andreu, Laurent Argaud, Claire Ara-Somohano, Francois Barbier, Jean-Pierre Bedos, Thomas Baudry, Jérome Bedel, Julien Bohé, Lila Bouadma, Jeremy Bourenne, Noel Brule, Frank Chemouni, Julien Carvelli, Elisabeth Coupez, Martin Cour, Claire Dupuis, Etienne de Montmollin, Loa Dopeux, Anne-Sylvie Dumenil, Jean-Marc Forel, Marc Gainnier, Charlotte Garret, Dany Goldgran-Tonedano, Steven Grangé, Antoine Gros, Hédia Hammed, Akim Haouache, Tarik Hissem, Vivien Hong Tuan Ha, Sébastien Jochman, Jean-Baptiste Joffredo, Hatem Kallel, Guillaume Lacave, Virgine Laurent, Alexandre Lautrette, Clément Le Bihan, Virgine Lemiale, David Luis, Guillaume Marcotte, Jordane Lebut, Mathild Neuville, Laurent Nicolet, Johanna Oziel, Laurent Papazian, Juliette Patrier, Benjamin Planquette, Aguila Radjou, Marie Simon, Romain Sonneville, Jean Reignier, Bertrand Souweine, Carole Schwebel, Shidasp Siami, Nicolas Terzi, Gilles Troché, Fabrice Thiollieres, Guillaume Thierry, Guillaume Van Der Meersch, Marion Venot, Florent Wallet, Sondes Yaacoubi, Olivier Zambon, Jonathan Zarka, Mireille Adda, Vanessa Vindrieux, Marion Provent, Sylvie de la Salle, Pauline Enguerrand, Vincent Gobert, Stéphane Guessens, Helene Merle, Nadira Kaddour, Boris Berthe, Samir Bekkhouche, Kaouttar Mellouk, Mélaine Lebrazic, Carole Ouisse, Diane Maugars, Christelle Aparicio, Igor Theodose, Manal Nouacer, Veronique Deiler, Fariza Lamara, Myriam Moussa, Atika Mouaci, Nassima Viguier
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/678a69ce7196420c9fd2df3be162c8f5
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institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Etienne de Montmollin, MD, PhD Carole Schwebel, MD, PhD Claire Dupuis, MD, PhD Maité Garrouste-Orgeas, MD Daniel da Silva, MD Elie Azoulay, MD, PhD Virginie Laurent, MD Guillaume Thiéry, MD, PhD Alexandra Grinea, MD Guillaume Marcotte, MD Johanna Oziel, MD Marc Gainnier, MD Shidasp Siami, MD, PhD Jean Reignier, MD, PhD Benjamin Sztrymf, MD, PhD Christophe Adrie, MD Stephane Ruckly, MSc Romain Sonneville, MD, PhD Jean-François Timsit, MD, PhD on behalf of the OUTCOMEREA Study Group Jean-François Timsit Elie Azoulay Jean-Ralph Zahar Bruno Mourvillier Michael Darmon Jean-Francois Timsit Corinne Albert Stephane Ruckly Sébastien Bailly Aurélien Vannieuwenhuyze Christophe Adrie Carole Agasse Bernard Allaouchiche Olivier Andremont Pascal Andreu Laurent Argaud Claire Ara-Somohano Elie Azoulay Francois Barbier Jean-Pierre Bedos Thomas Baudry Jérome Bedel Julien Bohé Lila Bouadma Jeremy Bourenne Noel Brule Frank Chemouni Julien Carvelli Elisabeth Coupez Martin Cour Michael Darmon Claire Dupuis Etienne de Montmollin Loa Dopeux Anne-Sylvie Dumenil Jean-Marc Forel Marc Gainnier Charlotte Garret Dany Goldgran-Tonedano Steven Grangé Antoine Gros Hédia Hammed Akim Haouache Tarik Hissem Vivien Hong Tuan Ha Sébastien Jochman Jean-Baptiste Joffredo Hatem Kallel Guillaume Lacave Virgine Laurent Alexandre Lautrette Clément Le Bihan Virgine Lemiale David Luis Guillaume Marcotte Jordane Lebut Bruno Mourvillier Mathild Neuville Laurent Nicolet Johanna Oziel Laurent Papazian Juliette Patrier Benjamin Planquette Aguila Radjou Marie Simon Romain Sonneville Jean Reignier Bertrand Souweine Carole Schwebel Shidasp Siami Nicolas Terzi Gilles Troché Fabrice Thiollieres Guillaume Thierry Guillaume Van Der Meersch Marion Venot Florent Wallet Sondes Yaacoubi Olivier Zambon Jonathan Zarka Mireille Adda Vanessa Vindrieux Marion Provent Sylvie de la Salle Pauline Enguerrand Vincent Gobert Stéphane Guessens Helene Merle Nadira Kaddour Boris Berthe Samir Bekkhouche Kaouttar Mellouk Mélaine Lebrazic Carole Ouisse Diane Maugars Christelle Aparicio Igor Theodose Manal Nouacer Veronique Deiler Fariza Lamara Myriam Moussa Atika Mouaci Nassima Viguier Life Support Limitations in Mechanically Ventilated Stroke Patients
description	Objectives:. The determinants of decisions to limit life support (withholding or withdrawal) in ventilated stroke patients have been evaluated mainly for patients with intracranial hemorrhages. We aimed to evaluate the frequency of life support limitations in ventilated ischemic and hemorrhagic stroke patients compared with a nonbrain-injured population and to determine factors associated with such decisions. Design:. Multicenter prospective French observational study. Setting:. Fourteen ICUs of the French OutcomeRea network. PATIENTS:. From 2005 to 2016, we included stroke patients and nonbrain-injured patients requiring invasive ventilation within 24 hours of ICU admission. INTERVENTION:. None. MEASUREMENTS AND MAIN RESULTS:. We identified 373 stroke patients (ischemic, n = 167 [45%]; hemorrhagic, n = 206 [55%]) and 5,683 nonbrain-injured patients. Decisions to limit life support were taken in 41% of ischemic stroke cases (vs nonbrain-injured patients, subdistribution hazard ratio, 3.59 [95% CI, 2.78–4.65]) and in 33% of hemorrhagic stroke cases (vs nonbrain-injured patients, subdistribution hazard ratio, 3.9 [95% CI, 2.97–5.11]). Time from ICU admission to the first limitation was longer in ischemic than in hemorrhagic stroke (5 [3–9] vs 2 d [1–6] d; p < 0.01). Limitation of life support preceded ICU death in 70% of ischemic strokes and 45% of hemorrhagic strokes (p < 0.01). Life support limitations in ischemic stroke were increased by a vertebrobasilar location (vs anterior circulation, subdistribution hazard ratio, 1.61 [95% CI, 1.01–2.59]) and a prestroke modified Rankin score greater than 2 (2.38 [1.27–4.55]). In hemorrhagic stroke, an age greater than 70 years (2.29 [1.43–3.69]) and a Glasgow Coma Scale score less than 8 (2.15 [1.08–4.3]) were associated with an increased risk of limitation, whereas a higher nonneurologic admission Sequential Organ Failure Assessment score was associated with a reduced risk (per point, 0.89 [0.82–0.97]). Conclusions:. In ventilated stroke patients, decisions to limit life support are more than three times more frequent than in nonbrain-injured patients, with different timing and associated risk factors between ischemic and hemorrhagic strokes.
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author	Etienne de Montmollin, MD, PhD Carole Schwebel, MD, PhD Claire Dupuis, MD, PhD Maité Garrouste-Orgeas, MD Daniel da Silva, MD Elie Azoulay, MD, PhD Virginie Laurent, MD Guillaume Thiéry, MD, PhD Alexandra Grinea, MD Guillaume Marcotte, MD Johanna Oziel, MD Marc Gainnier, MD Shidasp Siami, MD, PhD Jean Reignier, MD, PhD Benjamin Sztrymf, MD, PhD Christophe Adrie, MD Stephane Ruckly, MSc Romain Sonneville, MD, PhD Jean-François Timsit, MD, PhD on behalf of the OUTCOMEREA Study Group Jean-François Timsit Elie Azoulay Jean-Ralph Zahar Bruno Mourvillier Michael Darmon Jean-Francois Timsit Corinne Albert Stephane Ruckly Sébastien Bailly Aurélien Vannieuwenhuyze Christophe Adrie Carole Agasse Bernard Allaouchiche Olivier Andremont Pascal Andreu Laurent Argaud Claire Ara-Somohano Elie Azoulay Francois Barbier Jean-Pierre Bedos Thomas Baudry Jérome Bedel Julien Bohé Lila Bouadma Jeremy Bourenne Noel Brule Frank Chemouni Julien Carvelli Elisabeth Coupez Martin Cour Michael Darmon Claire Dupuis Etienne de Montmollin Loa Dopeux Anne-Sylvie Dumenil Jean-Marc Forel Marc Gainnier Charlotte Garret Dany Goldgran-Tonedano Steven Grangé Antoine Gros Hédia Hammed Akim Haouache Tarik Hissem Vivien Hong Tuan Ha Sébastien Jochman Jean-Baptiste Joffredo Hatem Kallel Guillaume Lacave Virgine Laurent Alexandre Lautrette Clément Le Bihan Virgine Lemiale David Luis Guillaume Marcotte Jordane Lebut Bruno Mourvillier Mathild Neuville Laurent Nicolet Johanna Oziel Laurent Papazian Juliette Patrier Benjamin Planquette Aguila Radjou Marie Simon Romain Sonneville Jean Reignier Bertrand Souweine Carole Schwebel Shidasp Siami Nicolas Terzi Gilles Troché Fabrice Thiollieres Guillaume Thierry Guillaume Van Der Meersch Marion Venot Florent Wallet Sondes Yaacoubi Olivier Zambon Jonathan Zarka Mireille Adda Vanessa Vindrieux Marion Provent Sylvie de la Salle Pauline Enguerrand Vincent Gobert Stéphane Guessens Helene Merle Nadira Kaddour Boris Berthe Samir Bekkhouche Kaouttar Mellouk Mélaine Lebrazic Carole Ouisse Diane Maugars Christelle Aparicio Igor Theodose Manal Nouacer Veronique Deiler Fariza Lamara Myriam Moussa Atika Mouaci Nassima Viguier
author_facet	Etienne de Montmollin, MD, PhD Carole Schwebel, MD, PhD Claire Dupuis, MD, PhD Maité Garrouste-Orgeas, MD Daniel da Silva, MD Elie Azoulay, MD, PhD Virginie Laurent, MD Guillaume Thiéry, MD, PhD Alexandra Grinea, MD Guillaume Marcotte, MD Johanna Oziel, MD Marc Gainnier, MD Shidasp Siami, MD, PhD Jean Reignier, MD, PhD Benjamin Sztrymf, MD, PhD Christophe Adrie, MD Stephane Ruckly, MSc Romain Sonneville, MD, PhD Jean-François Timsit, MD, PhD on behalf of the OUTCOMEREA Study Group Jean-François Timsit Elie Azoulay Jean-Ralph Zahar Bruno Mourvillier Michael Darmon Jean-Francois Timsit Corinne Albert Stephane Ruckly Sébastien Bailly Aurélien Vannieuwenhuyze Christophe Adrie Carole Agasse Bernard Allaouchiche Olivier Andremont Pascal Andreu Laurent Argaud Claire Ara-Somohano Elie Azoulay Francois Barbier Jean-Pierre Bedos Thomas Baudry Jérome Bedel Julien Bohé Lila Bouadma Jeremy Bourenne Noel Brule Frank Chemouni Julien Carvelli Elisabeth Coupez Martin Cour Michael Darmon Claire Dupuis Etienne de Montmollin Loa Dopeux Anne-Sylvie Dumenil Jean-Marc Forel Marc Gainnier Charlotte Garret Dany Goldgran-Tonedano Steven Grangé Antoine Gros Hédia Hammed Akim Haouache Tarik Hissem Vivien Hong Tuan Ha Sébastien Jochman Jean-Baptiste Joffredo Hatem Kallel Guillaume Lacave Virgine Laurent Alexandre Lautrette Clément Le Bihan Virgine Lemiale David Luis Guillaume Marcotte Jordane Lebut Bruno Mourvillier Mathild Neuville Laurent Nicolet Johanna Oziel Laurent Papazian Juliette Patrier Benjamin Planquette Aguila Radjou Marie Simon Romain Sonneville Jean Reignier Bertrand Souweine Carole Schwebel Shidasp Siami Nicolas Terzi Gilles Troché Fabrice Thiollieres Guillaume Thierry Guillaume Van Der Meersch Marion Venot Florent Wallet Sondes Yaacoubi Olivier Zambon Jonathan Zarka Mireille Adda Vanessa Vindrieux Marion Provent Sylvie de la Salle Pauline Enguerrand Vincent Gobert Stéphane Guessens Helene Merle Nadira Kaddour Boris Berthe Samir Bekkhouche Kaouttar Mellouk Mélaine Lebrazic Carole Ouisse Diane Maugars Christelle Aparicio Igor Theodose Manal Nouacer Veronique Deiler Fariza Lamara Myriam Moussa Atika Mouaci Nassima Viguier
author_sort	Etienne de Montmollin, MD, PhD
title	Life Support Limitations in Mechanically Ventilated Stroke Patients
title_short	Life Support Limitations in Mechanically Ventilated Stroke Patients
title_full	Life Support Limitations in Mechanically Ventilated Stroke Patients
title_fullStr	Life Support Limitations in Mechanically Ventilated Stroke Patients
title_full_unstemmed	Life Support Limitations in Mechanically Ventilated Stroke Patients
title_sort	life support limitations in mechanically ventilated stroke patients
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/678a69ce7196420c9fd2df3be162c8f5
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spelling	oai:doaj.org-article:678a69ce7196420c9fd2df3be162c8f52021-11-25T07:53:52ZLife Support Limitations in Mechanically Ventilated Stroke Patients2639-802810.1097/CCE.0000000000000341https://doaj.org/article/678a69ce7196420c9fd2df3be162c8f52021-02-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000341https://doaj.org/toc/2639-8028Objectives:. The determinants of decisions to limit life support (withholding or withdrawal) in ventilated stroke patients have been evaluated mainly for patients with intracranial hemorrhages. We aimed to evaluate the frequency of life support limitations in ventilated ischemic and hemorrhagic stroke patients compared with a nonbrain-injured population and to determine factors associated with such decisions. Design:. Multicenter prospective French observational study. Setting:. Fourteen ICUs of the French OutcomeRea network. PATIENTS:. From 2005 to 2016, we included stroke patients and nonbrain-injured patients requiring invasive ventilation within 24 hours of ICU admission. INTERVENTION:. None. MEASUREMENTS AND MAIN RESULTS:. We identified 373 stroke patients (ischemic, n = 167 [45%]; hemorrhagic, n = 206 [55%]) and 5,683 nonbrain-injured patients. Decisions to limit life support were taken in 41% of ischemic stroke cases (vs nonbrain-injured patients, subdistribution hazard ratio, 3.59 [95% CI, 2.78–4.65]) and in 33% of hemorrhagic stroke cases (vs nonbrain-injured patients, subdistribution hazard ratio, 3.9 [95% CI, 2.97–5.11]). Time from ICU admission to the first limitation was longer in ischemic than in hemorrhagic stroke (5 [3–9] vs 2 d [1–6] d; p < 0.01). Limitation of life support preceded ICU death in 70% of ischemic strokes and 45% of hemorrhagic strokes (p < 0.01). Life support limitations in ischemic stroke were increased by a vertebrobasilar location (vs anterior circulation, subdistribution hazard ratio, 1.61 [95% CI, 1.01–2.59]) and a prestroke modified Rankin score greater than 2 (2.38 [1.27–4.55]). In hemorrhagic stroke, an age greater than 70 years (2.29 [1.43–3.69]) and a Glasgow Coma Scale score less than 8 (2.15 [1.08–4.3]) were associated with an increased risk of limitation, whereas a higher nonneurologic admission Sequential Organ Failure Assessment score was associated with a reduced risk (per point, 0.89 [0.82–0.97]). Conclusions:. In ventilated stroke patients, decisions to limit life support are more than three times more frequent than in nonbrain-injured patients, with different timing and associated risk factors between ischemic and hemorrhagic strokes.Etienne de Montmollin, MD, PhDCarole Schwebel, MD, PhDClaire Dupuis, MD, PhDMaité Garrouste-Orgeas, MDDaniel da Silva, MDElie Azoulay, MD, PhDVirginie Laurent, MDGuillaume Thiéry, MD, PhDAlexandra Grinea, MDGuillaume Marcotte, MDJohanna Oziel, MDMarc Gainnier, MDShidasp Siami, MD, PhDJean Reignier, MD, PhDBenjamin Sztrymf, MD, PhDChristophe Adrie, MDStephane Ruckly, MScRomain Sonneville, MD, PhDJean-François Timsit, MD, PhDon behalf of the OUTCOMEREA Study GroupJean-François TimsitElie AzoulayJean-Ralph ZaharBruno MourvillierMichael DarmonJean-Francois TimsitCorinne AlbertStephane RucklySébastien BaillyAurélien VannieuwenhuyzeChristophe AdrieCarole AgasseBernard AllaouchicheOlivier AndremontPascal AndreuLaurent ArgaudClaire Ara-SomohanoElie AzoulayFrancois BarbierJean-Pierre BedosThomas BaudryJérome BedelJulien BohéLila BouadmaJeremy BourenneNoel BruleFrank ChemouniJulien CarvelliElisabeth CoupezMartin CourMichael DarmonClaire DupuisEtienne de MontmollinLoa DopeuxAnne-Sylvie DumenilJean-Marc ForelMarc GainnierCharlotte GarretDany Goldgran-TonedanoSteven GrangéAntoine GrosHédia HammedAkim HaouacheTarik HissemVivien Hong Tuan HaSébastien JochmanJean-Baptiste JoffredoHatem KallelGuillaume LacaveVirgine LaurentAlexandre LautretteClément Le BihanVirgine LemialeDavid LuisGuillaume MarcotteJordane LebutBruno MourvillierMathild NeuvilleLaurent NicoletJohanna OzielLaurent PapazianJuliette PatrierBenjamin PlanquetteAguila RadjouMarie SimonRomain SonnevilleJean ReignierBertrand SouweineCarole SchwebelShidasp SiamiNicolas TerziGilles TrochéFabrice ThiollieresGuillaume ThierryGuillaume Van Der MeerschMarion VenotFlorent WalletSondes YaacoubiOlivier ZambonJonathan ZarkaMireille AddaVanessa VindrieuxMarion ProventSylvie de la SallePauline EnguerrandVincent GobertStéphane GuessensHelene MerleNadira KaddourBoris BertheSamir BekkhoucheKaouttar MelloukMélaine LebrazicCarole OuisseDiane MaugarsChristelle AparicioIgor TheodoseManal NouacerVeronique DeilerFariza LamaraMyriam MoussaAtika MouaciNassima ViguierWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 2, p e0341 (2021)

Life Support Limitations in Mechanically Ventilated Stroke Patients

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