Stroke and Pneumonia: Mechanisms, Risk Factors, Management, and Prevention

Grossmann, I; Rodriguez, Kevin; Soni, Mridul; Joshi, Pranay K.; Patel, Saawan C.; Shreya, Devarashetty; Zamora, Diana; Patel, Gautami S.; Sange, Ibrahim

doi:10.7759/cureus.19912

Cited by 26 publications

(27 citation statements)

References 52 publications

(50 reference statements)

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“…However, in the multivariate analysis, only the older age and an SAP history retained their prognostic value as independent predictors of a new SAP development. The unfavorable prognostic role of SAP that developed in the earlier CS phases is probably related to the persistence of risk factors, such as dysphagia and/or immunosuppression, which increase the risk of pneumonia (Armstrong & Mosher, 2011;Grossmann et al, 2021). The prognostic model for assessing the risk of SAP proved adequate and was characterized by excellent (85.7%) sensitivity and good (75.0%) specificity.…”

Section: Discussionmentioning

confidence: 98%

“…Therefore, in patients who have both independent predictors of a new SAP (i.e., older age and an SAP history) careful monitoring of body temperature and blood oxygen saturation, as well as chest radiography immediately upon admission and in case of deterioration may make sense regardless of the CS phase. In addition, in such patients, special preventive measures may be used in order to reduce the risk of SAP, including endoscopic examination of the function of swallowing to rule out "silent" aspiration, education on safer food consistency and intake, correct positioning in bed and during meals, early and sufficient mobilization by Nurses and Physical Therapists, breathing exercises and good nutritional support (Armstrong & Mosher, 2011;Grossmann et al, 2021;Tinker et al, 2021). Future studies should aim at identifying more SAP modifiable risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that SAP is associated with worse neurological and functional recovery and more than triples the risk of death (Armstrong & Mosher, 2011;Ingeman et al, 2011;Yuan et al, 2021). Despite the fact that reducing the risk of SAP could have a significant impact on CS outcome, effective medical (in particular, with antimicrobial agents) prevention of SAP has not yet been developed, and the risk factors of SAP in different periods of the disease have not been sufficiently studied (Grossmann et al, 2021;Liu et al, 2016;Zheng et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Stroke-associated pneumonia risk estimation in patients admitted to a comprehensive stroke unit at different phases after stroke

Flomin

Honchar²

2023

USMYJ

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stroke is one of the leading causes of death and acquired disability among adults worldwide. Various complications frequently occur in patients with stroke and can significantly increase the risk for poor outcomes. Stroke-associated pneumonia, with the rate of up to 15%, is considered the most common serious medical complication in stroke patients. The aim of the study was to determine the independent predictors of the stroke-associated pneumonia in patients admitted to a comprehensive stroke unit at different time from stroke onset, as well as to develop a prognostic model for stroke-associated pneumonia risk estimation. Medical complications, including stroke-associated pneumonia, were documented in patients with clinical diagnosis of intraparenchymal cerebral stroke at admission and during their stay on the comprehensive stroke unit in 2010 to 2018. The workup at admission included assessment using the National Institutes of Health Stroke Scale and the modified Rankin scale. The diagnosis of stroke-associated pneumonia was made by specialists, in accordance with Centers for Disease Control recommendations. Qualitative variables are displayed as numbers and percentages, quantitative variables are displayed using the median (interquartile range). The method of logistic regression models was used to quantitatively assess the impact of characteristics on the PSP risk. The analysis was carried out using the package MedCalc v. 19.1. The study enrolled 539 patients, 309 (57.3%) men and 230 (42.7%) women. Median age of the patients was 66.0 years (57.9-75.1). Among the participants 101 (18.7%) were diagnosed with intracerebral hemorrhage, and 438 (81.3%) were diagnosed with ischemic stroke. Median initial National Institutes of Health Stroke Scale total score was 11 (6–18), median baseline modified Rankin scale score was 4 (3–5). Majority (64.1%) individuals were admitted within the first 30 days from onset, while 194 (35.9%) patients presented later. History of medical complications before the admission was present in 192 (35.6%) of the study participants, while during our in-hospital stay they occurred in 103 (19.1%) of the patients. The rate of new medical complications at the unit was significantly lower (p<0.001) than prior to the admission. The diagnosis of stroke-associated pneumonia before the admission was established in 20 (3.7%), and during our in-patient treatment was made in 7 (1.3%) subjects (p<0.001). Independent predictors of the stroke-associated pneumonia development were older age (odds ratio 1.11; 95% confidence interval 1.02-1.21, on average, for each additional year, p=0.02) and history of stroke-associated pneumonia at admission (odds ratio 12.2; 95 % confidence interval 2.0-72.4, p=0.006). Excellent sensitivity (85.7%), good specificity (75.0%) and area under the operating characteristic curve of 0.86 (95% confidence interval 0.83 – 0.89) for the developed prognostic model based on these of two variables, indicate their strong association with the risk of stroke-associated pneumonia during a comprehensive stroke unit stay. Therefore, stroke patients frequently develop medical complications at various stroke phases. The risk of stroke-associated pneumonia is higher in older patients and, especially, in those with stroke-associated pneumonia history. The lower rate of medical complications, in particular stroke-associated pneumonia, observed during in-hospital stay compared to the period prior to the admission may indicate the benefits of comprehensive stroke unit.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stroke-associated pneumonia risk estimation in patients admitted to a comprehensive stroke unit at different phases after stroke

Flomin

Honchar²

2023

USMYJ

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“…A tosse é um importante mecanismo de defesa e proteção da via aérea, sendo comumente prejudicada após o AVE, o que aumenta incidência de infecções pulmonares 9,10 . A pneumonia está entre as principais causas de morte após as primeiras semanas do evento agudo, sendo responsável por um aumento significativo dos custos com internamento hospitalar [11][12][13] .…”

Section: Artigo Originalunclassified

Correlação entre pico de fluxo de tosse e controle postural em indivíduos após ave na fase subaguda hospitalar

Santos¹,

Guerreiro²,

Neto³

2022

cmbio

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Introdução: o Acidente Vascular Encefálico (AVE) caracteriza-se por um déficit neurológico agudo e está entre as principais causas de mortalidade e incapacidade no mundo. As complicações respiratórias são responsáveis pelo aumento dos custos com internamento hospitalar e estão associadas a piores desfechos funcionais. Objetivo: investigar a correlação entre o pico de fluxo da tosse e o controle postural em indivíduos após AVE na fase subaguda hospitalar. Metodologia: trata-se de um estudo observacional, de delineamento transversal, com indivíduos diagnosticados com AVE, em um hospital de referência em neurologia da rede pública estadual. Para quantificação do pico de fluxo da tosse (PFT) foi utilizado o aparelho Peak Flow Meter e para avaliação do controle postural a Escala de avaliação postural para pacientes após AVE (EAPA). A análise da correlação foi realizada utilizando-se o coeficiente de Pearson. Resultados: a amostra foi composta por 28 voluntários, com média de idade de 57,39±15,1 anos, em sua maior parte com diagnóstico de AVE isquêmico (78,6%), hemiparesia esquerda (70,8%), sexo feminino (67,9%), tempo médio de internação de 21,6±18,0 dias, média do PFT 193,5±93,8 e de EAPA 21,6±11,0. Foi encontrada correlação positiva de moderada a boa entre o PFT e a EAPA (r= 0.52; p= 0.006). Conclusão: existe correlação positiva de moderada a boa entre capacidade da tosse e controle postural em indivíduos com AVE na fase subaguda hospitalar. Compreender essas alterações auxilia na sistematização dos programas de prevenção e reabilitação, desde o internamento.

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“…Yet, these treatments do not guarantee full recovery after stroke and so the demand for rehabilitation and long-term care rises given the increasing number of stroke survivors. Common detrimental clinical outcomes after stroke are functional and cognitive impairment (7)(8)(9), disability (10), malnutrition (11-13), skeletal muscle mass loss (14), oropharyngeal dysphagia (OD), altered systemic immunity, and systemic illnesses such as aspiration pneumonia (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Malnutrition risk and oropharyngeal dysphagia in the chronic post-stroke phase

Huppertz

Pilz²,

Cunha³

et al. 2022

Front. Neurol.

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BackgroundOropharyngeal dysphagia (OD) and malnutrition are associated with poor clinical outcomes after stroke. The present study evaluated (1) malnutrition risk and OD-related characteristics in patients with chronic post-stroke OD, and (2) the relationship between on the one hand OD severity and on the other hand functional oral intake and dysphagia-specific quality of life.MethodsA cross-sectional study was conducted in a Dutch interdisciplinary outpatient clinic for OD. The standardized examination protocol comprised: clinical ear, nose, and throat examination, body mass index, the short nutritional assessment questionnaire (SNAQ), a standardized fiberoptic endoscopic evaluation of swallowing (FEES), the functional oral intake scale (FOIS), and the MD Anderson dysphagia inventory (MDADI).ResultsForty-two consecutive patients with chronic post-stroke OD were included. Mean (±SD) age and BMI of the population were 69.1 (±8.7) years and 26.8 (±4.1) kg/m2 respectively. Seventeen (40.4%) patients presented a moderate to high risk of malnutrition (SNAQ score≥2). The FEES examination showed moderate to severe OD in 28 (66.7%) patients. The severity of OD was significantly related to the FOIS score but not to the MDADI scores.ConclusionIn this specific sample of referred stroke patients, moderate to severe OD and moderate to high risk of malnutrition were common. Despite the use of clinical practice guidelines on stroke and a normal nutritional status at first sight, repeated screening for malnutrition and monitoring the severity and management of OD remain important elements in the care of patients with chronic post-stroke OD.

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Stroke and Pneumonia: Mechanisms, Risk Factors, Management, and Prevention

Cited by 26 publications

References 52 publications

Stroke-associated pneumonia risk estimation in patients admitted to a comprehensive stroke unit at different phases after stroke

Stroke-associated pneumonia risk estimation in patients admitted to a comprehensive stroke unit at different phases after stroke

Correlação entre pico de fluxo de tosse e controle postural em indivíduos após ave na fase subaguda hospitalar

Malnutrition risk and oropharyngeal dysphagia in the chronic post-stroke phase

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