The Effect Of Low Tidal Volume Ventilation Strategy On Clinical Prognosis Of Patients With Severe Ischemic Stroke

Objective: This study aims to investigate the influence of LTVVS(low tidal volume ventilation strategy)on the clinical prognosis of patients with severe ischemic stroke,to clarify whether ventilation strategy is an independent factor for the clinical prognostic of patients with severe ischemic stroke.Methods: 131 patients with severe ischemic stroke who met the study criteria in the neurologic intensive care unit of The Second Hospital of Dalian Medical University from August 2017 to November 2020 were collected retrospectively.According to the average tidal volume,patients were divided into LTVVS group and non-LTVVS group,collected patients’ basic indicators and outcome indicators,analyzed the differences between the LTVVS group and non-LTVVS group,explored the effect of LTVVS on the clinical prognosis of patients with severe ischemic stroke.The basic indicators include gender,age,TOAST classification,ischemic stroke site,hemoglobin(Hb)level,albumin(Alb)level,average heart rate during mechanical,average blood pressure during mechanical,average arterial partial pressure of carbon dioxide(Pa CO2)during mechanical,average arterial partial pressure of oxygen(Pa O2)during mechanical,average PH during mechanical,NIHSS(national institutes of health stroke scale)score on admission,SOFA(sepsis-related organ failure assessment)score on admission,APACHE Ⅱ(acute physiology and chronic health evaluation Ⅱ)score on admission,GCS(glasgow coma scale)score on admission,complications(hepatic insufficiency,cardiac insufficiency,renal insufficiency,acute coronary syndrome,atrial fibrillation,hypertension,diabetes),the clinical outcome indicators include length of hospital stay,length of stay in ICU(Intensive Care Unit),duration of using antibiotics,mechanical ventilation time,occurrence of pneumonia,duration of using vasoactive drugs,and hospital mortality.According to the clinical prognosis of the patients during hospitalization,the patients were regrouped into survival group and death group.Differences between the two groups in basic information,incidence of pneumonia and mechanical ventilation strategy were analyzed,and the independent risk factors affecting the death outcome of patients with severe ischemic stroke were further analyzed.Results: 1.Basic information:131 patients were enrolled in this study.60 patients in the LTVVS group,including 22 males(36.67%)with a median age of 69 years,23 patients(38.33%)with cardiac dysfunction,the median heart rate during mechanical was 90 beats/min and the median Pa O2 during mechanical was 114 mm Hg.71 patients in the non-LTVVS group,including 40 males(56.34%)with a median age of 75 years,13 patients(18.31%)with cardiac dysfunction,the median heart rate during mechanical was 101 beats/min and the median Pa O2 during mechanical was 110 mm Hg.There were significant differences between the two groups in gender(P=0.04),age(P=0.02),average heart rate during mechanical(P<0.05),average Pa O2 during mechanical(P=0.03)and the incidence of cardiac dysfunction(P=0.02).There were no statistically significant differences in ischemic stroke site,TOAST classification,Alb level,Hb level,average blood pressure during mechanical,average Pa CO2 during mechanical,average PH during mechanical,complications,scores on admission(P > 0.05).2.Prognostic indicators:(1)The mechanical ventilation time [9(7-11)vs 11(8-15),P<0.05],duration of using vasoactive drugs [16(13-20)vs 18(13-23),P=0.04] and length of hospital stay in LTVVS group [18(15-21)vs 20(16-26),P=0.02] were shorter than those in non-LTVVS group,and the hospital mortality(18.33% vs 38.03%,P=0.02)was lower than that in non-LTVVS group,with statistical significance between the two groups(P < 0.05).(2)There was no statistical significance in the length of stay in ICU [16(13-19)vs 16(13-20),P=0.57],the incidence of pneumonia(28.33% vs 30.99%,P=0.85)and the duration of using vasoactive drugs(50.00% vs 45.07%,P=0.60)between the LTVVS group and non-LTVVS group(P > 0.05).3.Risk factors: Logistic regression analysis concluded that mechanical ventilation strategy(OR=0.37,95%CI=0.16-0.99),higher NIHSS score on admission(OR=1.10,95%CI=1.02-1.20)and higher SOFA score on admission(OR=1.34,95%CI=1.02-1.77)were independent risk factors for clinical prognosis of patients with severe ischemic stroke,low volume ventilation strategy was a protective factor for clinical prognostic of patients with severe ischemic stroke.Conclusion: LTVVS can shorten the mechanical ventilation time,antibiotic use time and hospitalization time,reduce the hospital mortality.Patients’ mechanical ventilation strategy and higher NIHSS score on admission and higher SOFA score on admission are the independent risk factors for clinical prognostic in patients with severe ischemic stroke,the LTVVS is a protective factor for influencing clinical prognostic of patients with severe ischemic stroke.