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Reply from the Authors: We thank Dr. Meschia for his remarks. Dr. Meschia criticizes us for not matching the ventilated patients to the nonventilated ones for severity of lung disease, e.g., respiratory acidosis, hypoxemia, hypercapnia, pneumonia, or adult respiratory distress syndrome. Had the severity been comparable, all patients should have been ventilated. The conclusions of our work were that if a stroke is complicated by acute respiratory insufficiency, justifying mechanical ventilation, there are almost no chances for survival; thus the very institution of mechanical ventilation should be very carefully considered.
We suspect that Dr. Meschia misunderstood the simple message of the study-63 of a total of 936 nonventilated stroke patients died in the hospital(6.7%) compared with 47 of a total of 53 ventilated stroke patients (88.7%). A persistent vegetative state evolved in two of the six ventilated survivors, and the other four were severely handicapped and required chronic nursing care without any chance for …
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