Ventilator-associated pneumonia in critically ill stroke patients: Frequency, risk factors, and outcomes

Kasuya, Yuko; Hargett, James L.; Lenhardt, Rainer; Heine, Michael F.; Doufas, Anthony G.; Remmel, Kerri; Ramirez, Julio A.; Akça, Ozan

doi:10.1016/j.jcrc.2010.09.006

Cited by 55 publications

(46 citation statements)

References 35 publications

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“…The occurrence was much higher among febrile patients (40.2-70.8%) [55,56] reflecting the importance of SAP as a cause of fever after stroke. Among MICU studies, this incidence has ranged between 17 and 50% [12,23,49,57,58] and appeared to be similar to NICU studies. The majority of SAP studies have been performed in stroke units or in mixed acute settings.…”

Section: Incidence Of Sapsupporting

confidence: 57%

“…Another classification in use divides SAP into acute (when pneumonia develops within a month of stroke) and chronic (when it occurs later than a month) [10]. Clinical SAP studies used a wide range of criteria to define SAP starting from the Center of Disease Control and Prevention criteria to investigating ventilator-associated pneumonia after stroke to reviewing patients' diagnosis from the charts [1,5,12]. We will use the Center of Disease Control and Prevention criteria to define nosocomial pneumonia [13], as they are the most widely used ones among the studies [14,15].…”

Section: Definitions and General Termsmentioning

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 Sapsupporting

confidence: 57%

Section: Definitions and General Termsmentioning

confidence: 99%

Stroke-Associated Pneumonia: Major Advances and Obstacles

et al. 2013

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“…Thus, it is possible an early intervention, adopting measures such as early mobilization, evaluation of swallowing and respiratory function in patients with suspect or confirmed pneumonia 25,26 . Prevention and early rehabilitation may decrease the risk of complications, reducing mortality and improving prognosis after acute ischemic stroke 27,28 .…”

Section: Discussionmentioning

confidence: 99%

“…Most patients were discharged home (115, 72.3%), and others died (25,15.7%) or were transferred to other hospital (19, 11.9%). Ischemic and hemorrhagic stroke were diagnosed in (129, 81.1%) and (30,18.9%) patients, respectively.…”

Section: Study Population and Stroke Characteristicsmentioning

confidence: 99%

Predictors of pneumonia in acute stroke in patients in an emergency unit

Almeida

Bahia

Lima

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years) were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001), higher National Institute of Health Stroke Scale (NIHSS) (p = 0.047) and, lower Glasgow Coma Score (GCS) (p < 0.0001). Patients with pneumonia had longer hospitalization (p < 0.0001). Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002). Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

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“…Hence, our results support the hypothesis that shorter ventilation times are associated with lower pneumonia rates and a more favorable clinical outcome. [21][22][23] When we investigated the influence of ventilation times via various cutoffs, multivariate analyses indicated that longer ventilation times resulted in higher pneumonia rates, regardless of the time of cutoff (Online Table 2). However, multivariate analysis also indicated that longer ventilation times per se had no independent impact on unfavorable functional outcome (P Ն .075).…”

Section: Ventilation Duration and Clinical Outcomementioning

confidence: 99%