Risk factors for prolonged mechanical ventilation in critically ill patients with ischemic stroke

Prolonged mechanical ventilation (PMV) is associated with increased morbidity and mortality among critically ill patients with ischemic stroke, yet data on its risk factors remain limited. This study aimed to identify independent predictors of PMV in this population. Ischemic stroke patients were identified from the Medical Information Mart for Intensive Care IV database. PMV was defined as mechanical ventilation lasting more than 14 days. Multivariable logistic regression was used to identify factors associated with PMV. Model performance was assessed using receiver operating characteristic curves, calibration plots, and decision curve analysis. A total of 756 ischemic stroke patients were included, of whom 111 (14.7 ​%) required PMV. In-hospital and one-year mortality rates in the PMV group were 27.0 ​% and 45.9 ​% respectively. Independent risk factors for PMV included BMI ≥33 ​kg/m² (OR 1.82, 95 ​% CI 1.10-3.02), COPD (OR 2.02, 95 ​% CI 1.25-3.24), pH ​≥ ​7.45 (OR 1.79, 95 ​% CI 1.12-2.86), respiratory rate ≥20 min^-1 (OR 2.39, 95 ​% CI 1.47-3.88), sepsis onset before D14 (OR 8.48, 95 ​% CI 1.75-41.06), tracheostomy (OR 7.38, 95 ​% CI 4.38-12.44), vasopressor (OR 2.19, 95 ​% CI 1.26-3.79) and pneumonia onset before D14 (OR 1.68, 95 ​% CI 1.01-2.79). These variables were incorporated into a nomogram, which demonstrated good discrimination (AUC 0.86, 95 ​% CI 0.83-0.89) and calibration (Hosmer-Lemeshow P ​= ​0.149). In conclusion, PMV in critically ill ischemic stroke patients is associated with COPD, sepsis, obesity, alkalosis, increased respiratory rate, tracheostomy, vasopressor use, and pneumonia. The predictive model incorporating these factors showed good diagnostic performance and may aid early risk stratification and management.