[Russian multicenter observational clinical study «Register of respiratory therapy for patients with stroke (RETAS)»: a comparative analysis of the outcomes of stroke].

OBJECTIVE

To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death.

MATERIAL AND

METHODS

A multicenter observational clinical study «REspiratory Therapy for Acute Stroke» (RETAS) was conducted under the aegis of the «Federation of Anaesthesiologists and Reanimatologists» (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support.

RESULTS

We found that initial hypoxemia in the 28-day period was associated with higher mortality than in absence of hypoxemia (in patients with 20 or more NIHSS scores) (76.22% versus 63.45%, p=0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension compared with group of patients who were not treated with hyperventilation (in patients with 20 or more NIHSS scores) (79.55% versus 72.75%, p=0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIHSS scores) (p<0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (87.64% versus 62.33%, p<0.001). It has been proved that the absence of nutritional insufficiency in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) in comparison with patients with signs of nutritional insufficiency, for the group with NIHSS less than 14 points (p<0.001).

CONCLUSIONS

A group of factors associated with a deterioration in the prognosis of outcomes in patients with stroke who are undergoing ventilation has been identified: hypoxemia at the start of respiratory support, lack of instrumental monitoring of ICP, the use of hyperventilation to correct ICP, ventilation with volume control (VC), as well as the presence of nutritional insufficiency.