(284) Outcomes of Patients and Families After Severe Acute Brain Injury Requiring Mechanical Ventilation

Monday, January 22, 2024

11:30 AM – 12:30 PM MT

Location: Connections Central - RST 13

First Author(s)

NS

Natalie Smith

n/a

Co-Author(s)

AJ

Adrienne James, n/a

n/a
Department of Anesthesiology, University of Washington, Seattle, WA, United States
CF

Christine Fong, n/a

n/a
Department of Anesthesiology, University of Washington, Seattle, WA, United States
MS

Monisha Sharma, Ph.D

n/a
Department of Global Health, University of Washington, Seattle, WA, United States
NM

Nassim Matin, MD

n/a
Department of Neurology, University of Washington, Seattle, WA, United States
KS

Kasra Sarhadi, MD

n/a
Department of Neurology, University of Washington, Seattle, WA, United States
AL

Abhijit Lele, MD

n/a
Department of Anesthesiology; Department of Neurological Surgery University of Washington, Seattle, WA, United States
NM

Nicole Mazwi, MD

n/a
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
CR

Chiara Robba, MD

n/a
Departments of Anesthesia and Intensive Care, Policlinico San Martino, United States
CC

Claire J. Creutzfeldt, MD

n/a
Harborview Medical Center, United States
JT

James Town, MD

n/a
Harborview Medical Center, United States
SW

Sarah Wahlster, MD

n/a
Harborview Medical Center, United States

Introduction: Patients with severe acute brain injury (SABI) often require mechanical ventilation (MV) due to insufficient airway protection, reflecting substantial neurological injury. Long-term outcomes for this high-acuity population and their surrogate decision makers (SDM) have been insufficiently reported.

Methods: Prospective, observational cohort study at a Level-1 Trauma and Comprehensive Stroke Center (Seattle, WA). We enrolled consecutive patients between Sept-Nov 2021; eligibility criteria were: ≥18 years old, SABI including traumatic brain injury (TBI), spontaneous intracranial hemorrhage (sICH), acute ischemic stroke (AIS), and subarachnoid hemorrhage (SAH), requiring MV on admission. Patient outcomes included mortality at discharge, mortality and Glasgow Outcome Scale Extended (GOSE) score at 6-12 months and 18-24 months. SDM outcomes included major depressive disorder (MDD) (PHQ-2 score ≥3) and anxiety (GAD-2 ≥3) at 18-24 months.

Results: We included 103 patients (mean age 58), majority male (72%) and white (77%), insured via Medicare/Medicaid (65%) with 49% TBI, 20% sICH, 19% AIS, 12% SAH). Median initial Glasgow Coma Scale was 7 (IQR 3-11). Mortality was 46% in-hospital and 50% at 18-24 months; 67% of deaths occurred after withdrawal of life sustaining treatment (WLST). Among survivors, 67% were functionally independent (GOSE 5-8) by 6-12 months and 72.5% by 18-24 months; 31% of survivors with initial GOSE 2-4 at 6-12 months reached independence by 18-24 months. Overall, 57% of SDM had signs of MDD and 57% of anxiety, which was higher among SDM of survivors (GOSE 2-4: 67% MDD and 49% anxiety; GOSE 5-6: 67% and 72%; GOSE 7-8: 38% and 50%) compared to decedents (39% and 39% respectively).

Conclusions: Among patients with SABI requiring MV, half were dead at 2 years: most mortalities occurred during the initial hospitalization and two-thirds of in-hospital deaths occurred after WLST. Two thirds of survivors achieved functional independence by a year with few more reaching independence by 18 months, suggesting potential for improvement for some patients well past one year. The burden of mental health symptoms for SDMs was substantial overall and tended to be higher among SDM of survivors than those of deceased patients, with some differences based on functionality of survivors.