Jung Jae Wook, Kang Ilmo, Park Jin, Jeon Sang-Beom
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Sci Rep. 2025 Jan 8;15(1):1312. doi: 10.1038/s41598-025-85489-y.
We investigated the functional outcomes in ischemic stroke patients who underwent endotracheal intubation according to airway management (i.e., extubation success, extubation failure, primary tracheostomy) at multiple time points. Patients were classified into three groups: extubation success, extubation failure, and primary tracheostomy. Their functional outcomes were compared at hospital discharge, 3-month, and 1-year. Out of 165 ischemic stroke patients, 84 (50.9%) underwent extubation attempt and 81 (49.1%) underwent primary tracheostomy. Among the patients who underwent extubation, 26 (31.0%) experienced extubation failure. The extubation success group had a higher rate of achieving a favorable functional outcome (modified Rankin Scale 0-4) compared to the extubation failure group at hospital discharge (adjusted odds ratio [aOR] 3.93; 95% CI, 1.33-13.1; p = 0.018) and at 3-month (aOR 5.67; 95% CI 1.79-19.8; p = 0.004), but not at 1-year (aOR 2.99; 95% CI 0.96-9.68; p = 0.061). The primary tracheostomy group had a significantly lower rate of achieving a favorable functional outcome at all time points compared to the extubation failure group. These findings suggest that a condition suitable for an extubation attempt may be a more important 1-year prognostic indicator than extubation failure. Despite its limitations, this study suggests that the clinical condition prompting primary tracheostomy may outweigh extubation failure as a determinant of 1-year prognosis. However, prospective studies are needed to validate it and clarify its clinical implications.
我们在多个时间点调查了根据气道管理（即拔管成功、拔管失败、一期气管切开术）接受气管插管的缺血性中风患者的功能结局。患者被分为三组：拔管成功、拔管失败和一期气管切开术。比较了他们在出院时、3个月和1年时的功能结局。在165例缺血性中风患者中，84例（50.9%）尝试拔管，81例（49.1%）接受一期气管切开术。在接受拔管的患者中，26例（31.0%）拔管失败。与拔管失败组相比，拔管成功组在出院时（调整优势比[aOR] 3.93；95%置信区间，1.33 - 13.1；p = 0.018）和3个月时（aOR 5.67；95%置信区间1.79 - 19.8；p = 0.004）获得良好功能结局（改良Rankin量表0 - 4）的比例更高，但在1年时并非如此（aOR 2.99；95%置信区间0.96 - 9.68；p = 0.061）。与拔管失败组相比，一期气管切开术组在所有时间点获得良好功能结局的比例均显著较低。这些发现表明，适合尝试拔管的情况可能是比拔管失败更重要的1年预后指标。尽管本研究存在局限性，但提示一期气管切开术的临床情况作为1年预后的决定因素可能比拔管失败更重要。然而，需要前瞻性研究来验证这一点并阐明其临床意义。
