High Incidence of Respiratory Infections in ‘Nil by Mouth’ Tube-Fed Acute Ischemic Stroke Patients

Abstract

Background: Respiratory infections are common in acute stroke. Previous studies have found dysphagia is associated with respiratory infections. Of interest is whether patients who are ‘Nil by Mouth’ (NBM) and tube fed have higher risk of developing infections due to aspiration of bacteria-laden saliva or refluxed material than stroke patients who are fed orally. Methods: Prospective cohort of 330 ischemic stroke survivors were followed for 30 days and infections recorded. Results: 115 infections were treated with antibiotics; these included 51 respiratory infections. Incidence of infection in NBM tube-fed stroke patients (n = 74) was 69%, with 30 respiratory infections occurring in 74 patients who received enteral feeding after stroke. Logistic regression analysis showed tube feeding during admission was a significant risk for respiratory infection. We also saw a significant time-to-event effect with 73% (22/30) respiratory infections in tube-fed survivors diagnosed on days 2–4 after stroke, and 76% (39/51) of infections in all tube-fed survivors occurring by day 7 after stroke. Relevance to a theory of critical period of susceptibility to infection in acute stroke is discussed. Conclusions: NBM tube-fed survivors were unlikely to have aspirated anything other than saliva/secretions or reflux, yet experienced significantly higher rates of respiratory infections than survivors fed orally. Stringent oral care and measures to prevent reflux are potentially modifiable aspects of stroke management.

Association between nasogastric tubes, pneumonia, and clinical outcomes in acute stroke patients

“…[9][10][11] Evidence that NGT placement increases PSP incidence remains equivocal; observational studies suggesting this association are limited by heterogeneity in patients, settings, and diagnostic criteria for PSP. [6][7][8] It is possible that PSP and higher mortality are influenced by stroke severity rather than by NGT placement.…”

Dysphagia and Respiratory Infections in Acute Ischemic Stroke

“…Respiratory infection was significantly more likely to occur in patients with dysphagia (Langdon, Lee & Binns, 2007). In a cohort of 330 acute ischemic stroke patients followed up for the first month after their stroke, there were 51 respiratory infections, with dysphagia again a significant predictor of patients who developed infections (Langdon, Lee & Binns, 2009). …”

“…They found that the bacteria in the respiratory samples and those found in plaque were the same (El-Solh, Pietrantoni, Okada, Bhat, Zambon, Aquilina, and Berbery, 2004). Stringent oral care and strategies to minimize reflux in the acute stroke population has the potential to reduce respiratory infections (Langdon, Lee & Binns, 2009). …”

“…al., 2004). Langdon, Lee and Binns (2009) studied acute ischemic stroke patients and found the incidence of overall infections (respiratory, urinary tract and other infections) in stroke patients who were tube fed was 69%, with 51 infections occurring in 74 patients. Thirty of these infections were respiratory.…”

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“…Kommentar: Es gibt einige Hinweise, dass die Rate an Atemwegsinfekten bei sondenernährten dysphagischen Schlaganfallpatienten höher ist als bei oral ernährten Patienten [9,106]. Es kann jedoch davon ausgegangen werden, dass dies in den meisten Fällen am höheren Schweregrad der Dysphagie liegt, die der Grund für die Sondenernährung ist.…”