Reduction in the Incidence of Poststroke Nosocomial Pneumonia by Using the “Turn-mob” Program

Cuesy, Pilar Grajales; Sotomayor, Pilar Lavielle; Piña, Juan Osvaldo Talavera

doi:10.1016/j.jstrokecerebrovasdis.2009.02.009

Cited by 41 publications

(17 citation statements)

References 30 publications

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“…This could reflect a selection bias since all patients included in this study had nasogastric tube feeding, higher rate of mechanical ventilation (18%) and their strokes were more severe [mean baseline National Institutes of Health Stroke Scale (NIHSS) score = 13.4]. Studies performed in mixed acute settings found an incidence between 3.9 and 23.8% [4,5,9,16,18,48,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84], while the incidence among selected rehabilitation studies ranged between 3.2 and 11% [69,85,86,87]. …”

Section: Incidence Of Sapmentioning

confidence: 99%

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Stroke-Associated Pneumonia: Major Advances and Obstacles

et al. 2013

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Background: Stroke-associated pneumonia (SAP) has been implicated in the morbidity, mortality and increased medical cost after acute ischemic stroke. The annual cost of SAP during hospitalization in the United States approaches USD 459 million. The incidence and prognosis of SAP among intensive care unit (ICU) patients have not been thoroughly investigated. We reviewed the pathophysiology, microbiology, incidence, risk factors, outcomes and prophylaxis of SAP with special attention to ICU studies. Methods: To determine the incidence, risk factors and prognosis of acute SAP, PubMed was searched using the terms ‘pneumonia' AND ‘neurology intensive unit' and the MeSH terms ‘stroke' AND ‘pneumonia'. Non-English literature, case reports and chronic SAP studies were excluded. Studies were classified into 5 categories according to the setting they were performed in: neurological intensive care units (NICUs), medical intensive care units (MICUs), stroke units, mixed studies combining more than one setting or when the settings were not specified and rehabilitation studies. Results: The incidences of SAP in the following settings were: NICUs 4.1-56.6%, MICUs 17-50%, stroke units 3.9-44%, mixed studies 3.9-23.8% and rehabilitation 3.2-11%. The majority of NICU and MICU studies were heterogeneous including different neurovascular diseases, which partly explains the wide range of SAP incidence. The higher incidence in the majority of ICU studies compared to stroke units or acute floor studies is likely explained by the presence of mechanical ventilation, higher stroke severity causing higher rates of aspiration and stroke-induced immunodepression among ICU patients. The short-term mortality of SAP was increased among the mixed and stroke unit studies ranging between 10.1 and 37.3%. SAP was associated with worse functional outcome in the majority of stroke unit and floor studies. Mortality was less consistent among NICU and MICU studies. This difference could be due to the heterogeneity of ICU studies and the effect of small sample size or other independent risk factors for mortality such as the larger neurological deficit, mechanical ventilation, and age, which may simultaneously increase the risk of SAP and mortality confounding the outcomes of SAP itself. The pathophysiology of SAP is likely explained by aspiration combined with stroke-induced immunodepression through complex humeral and neural pathways that include the hypothalamic-pituitary-adrenal axis, parasympathetic and sympathetic systems. Conclusions: A unified definition of SAP, strict inclusion criteria, and the presence of a long-term follow-up need to be applied to the future prospective studies to better identify the incidence and prognosis of SAP, especially among ICU patients.

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Section: Incidence Of Sapmentioning

confidence: 99%

“…A recent Cochrane review of the clinical trials showed no difference between the two methods regarding the occurrence of pneumonia in patients with dysphagia; however, percutaneous gastrostomy tube was safer and more effective in terms of feeding [90]. Early mobilization is recommended as it decreases the risk for SAP [71]. …”

Section: Prophylaxis Of Sapmentioning

confidence: 99%

Stroke-Associated Pneumonia: Major Advances and Obstacles

et al. 2013

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“…Cuesy et al conducted a RCT evaluating the preventive effect of a “turn-mob” program for HAP [43]. The study included 223 non-ventilated patients with acute ischemic stroke.…”

Section: Measures For Hap Preventionmentioning

confidence: 99%

Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review

Pássaro

Harbarth

Landelle

2016

Antimicrob Resist Infect Control

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BackgroundPneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP) are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP).AimThe purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients.MethodsA search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis.FindingsRegarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided.ConclusionScant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high-quality studies are required to evaluate the impact of specific measures on HAP prevention in non-ventilated adult patients.

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“…Pneumonia is the most common clinical complication after stroke, and stroke severity was an independent risk factor for pneumonia in a retrospective cohort study 10. Moreover, pneumonia could be prevented in patients with acute stroke by adding a passive turning and mobilization program to usual care 11. The relationship between immobilization and infection is bidirectional, as infection often leads to bed‐rest and immobilization.…”

Section: Introductionmentioning

confidence: 99%

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Grimnes

Isaksen

Tichelaar

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials There is a bidirectional relation between acute infections and immobilizationWe studied the impact of infection and immobilization on risk of VTE in a case‐crossover designAcute infection was a strong trigger for VTE independent of concomitant immobilizationInfection and immobilization had a synergistic effect on the VTE‐risk BackgroundA bidirectional relation exists between acute infection and immobilization, and both are triggers for venous thromboembolism (VTE). To what extent the association between infection and VTE‐risk is explained by immobilization is unknown.AimsTo investigate the impact of hospitalization with acute infection on the VTE‐risk in patients with and without concomitant immobilization, and to explore the differential impact of respiratory‐ (RTI) and urinary‐ (UTI) tract infections on the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).MethodsWe conducted a case‐crossover study of VTE‐patients (n = 707) recruited from a general population. Hospitalizations and VTE‐triggers were registered during the 90 days before a VTE (hazard period) and in four preceding 90‐day control periods. Conditional logistic regression was used to estimate odds ratios (ORs) for VTE according to triggers.ResultsAcute infection was registered in 267 (37.8%) of the hazard periods and in 107 (3.8%) of the control periods, corresponding to a high VTE‐risk after infection (OR 24.2, 95% CI 17.2‐34.0), that was attenuated to 15‐fold increased after adjustment for immobilization. The risk was 20‐fold increased after infection without concomitant immobilization, 73‐fold increased after immobilization without infection, and 141‐fold increased with the two combined. The risk of PE was apparently higher after RTIs (OR 48.3, 95% CI 19.4‐120.0) than UTIs (OR 12.6, 95% CI 6.4‐24.7), but diminished in sensitivity analyses excluding uncertain RTI diagnoses.ConclusionsOur findings suggest that hospitalization with infection is a strong VTE‐trigger also in non‐immobilized patients. Infection and immobilization had a synergistic effect on the VTE‐risk.

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Reduction in the Incidence of Poststroke Nosocomial Pneumonia by Using the “Turn-mob” Program

Cited by 41 publications

References 30 publications

Stroke-Associated Pneumonia: Major Advances and Obstacles

Stroke-Associated Pneumonia: Major Advances and Obstacles

Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

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