Effect of early vs. delayed extubation on functional outcome among patients with acute ischemic stroke treated with endovascular thrombectomy under general anesthesia: the prospective, randomized controlled EDESTROKE trial study protocol

被引：0

作者：

Taboada, Manuel ^{[1
]}

Estany-Gestal, Ana ^{[2
]}

Fernandez, Jorge ^{[1
]}

Barreiro, Laura ^{[1
]}

Williams, Kora ^{[1
]}

Rodriguez-Yanez, Manuel ^{[3
]}

Otero, Pablo ^{[1
]}

Naveira, Alberto ^{[1
]}

Caruezo, Valentin ^{[1
]}

Veiras, Sonia ^{[1
]}

San Luis, Eva ^{[1
]}

Dos Santos, Laura ^{[1
]}

Diaz-Vieito, Maria ^{[1
]}

Arias-Rivas, Susana ^{[3
]}

Santamaria-Cadavid, Maria ^{[3
]}

Rodriguez-Castro, Emilio ^{[3
]}

Vazquez, Fernando ^{[4
]}

Blanco, Miguel ^{[4
]}

Mosquera, Antonio ^{[4
]}

Castineiras, Jose Antonio ^{[4
]}

Muniategui, Ignacio ^{[1
]}

Ferreiroa, Esteban ^{[1
]}

Carinena, Agustin ^{[1
]}

Tubio, Ana ^{[1
]}

Campana, Olga ^{[1
]}

Selas, Salome ^{[1
]}

Aneiros, Francisco ^{[1
]}

Martinez, Adrian ^{[1
]}

Eiras, Maria ^{[1
]}

Costa, Jose ^{[4
]}

Prieto, Jose Maria ^{[3
]}

Alarez, Julian ^{[1
]}

机构：

[1] Univ Clin Hosp Santiago, Dept Anesthesiol, Santiago, Spain

[2] Fdn Inst Inves Sanitarias FIDIS, Res Methodol Unit, Santiago, Spain

[3] Univ Clin Hosp Santiago, Dept Neurol, Santiago, Spain

[4] Univ Clin Hosp Santiago, Dept Neuroradiol, Santiago, Spain

来源：

TRIALS | 2024年 / 25卷 / 01期

关键词：

Stroke; Endovascular treatment; Extubation; Mechanical ventilation; Functional status; CONSCIOUS SEDATION; MANAGEMENT; IMPACT; THERAPY; SAFETY;

D O I：

10.1186/s13063-024-08181-y

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

Background Recent meta-analyses and randomized studies have shown that among patients with acute ischemic stroke undergoing endovascular thrombectomy, general anesthesia with mechanical ventilation is associated with better functional status compared to local anesthesia and sedation, and they recommend its use. But once the procedure is completed, when is the optimal moment for extubation? Currently, there are no guidelines recommending the optimal moment for extubation. Prolonged mechanical ventilation time could potentially be linked to increased complications such as pneumonia or disturbances in cerebral blood flow due to the vasodilatation produced by most anesthetic drugs. However, premature extubation in a patient who has suffered a stroke could led to complications such as agitation, disorientation, abolished reflexes, sudden fluctuations in blood pressure, alterations in cerebral blood flow, respiratory distress, bronchial aspiration, and the need for reintubation. We therefore designed a randomized study hypothesizing that early compared with delayed extubation is associated with a better functional outcome 3 months after endovascular thrombectomy treatment under general anesthesia for acute ischemic stroke. Methods This investigator-initiated, single-center, prospective, parallel, evaluated blinded, superiority, randomized controlled trial will include 178 patients with a proximal occlusion of the anterior circulation treated with successful endovascular thrombectomy (TICI 2b-3) under general anesthesia. Patients will be randomly allocated to receive early (<6 h) or delayed (6-12 h) extubation after the procedure. The primary outcome measure is functional independence (mRS of 0-2) at 90 days, measured with the modified Rankin Score (mRS), ranging from 0 (no symptoms) to 6 (death). Discussion This will be the first trial to compare the effect of mechanical ventilation duration (early vs delayed extubation) after satisfactory endovascular thrombectomy for acute ischemic stroke under general anesthesia.

引用

页数：11

共 21 条

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Zaidat, Osama O. ;

Yoo, Albert J. ;

Khatri, Pooja ;

Tomsick, Thomas A. ;

von Kummer, Ruediger ;

Saver, Jeffrey L. ;

Marks, Michael P. ;

Prabhakaran, Shyam ;

Kallmes, David F. ;

Fitzsimmons, Brian-Fred M. ;

Mocco, J. ;

Wardlaw, Joanna M. ;

Barnwell, Stanley L. ;

Jovin, Tudor G. ;

Linfante, Italo ;

Siddiqui, Adnan H. ;

Alexander, Michael J. ;

Hirsch, Joshua A. ;

Wintermark, Max ;

Albers, Gregory ;

Woo, Henry H. ;

Heck, Donald V. ;

Lev, Michael ;

Aviv, Richard ;

Hacke, Werner ;

Warach, Steven ;

Broderick, Joseph ;

Derdeyn, Colin P. ;

Furlan, Anthony ;

Nogueira, Raul G. ;

Yavagal, Dileep R. ;

Goyal, Mayank ;

Demchuk, Andrew M. ;

Bendszus, Martin ;

Liebeskind, David S. .

STROKE, 2013, 44 (09) :2650-2663

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