Dysphagia and Respiratory Infections in Acute Ischemic Stroke

Langdon, Claire

doi:10.5772/25748

Cited by 4 publications

(3 citation statements)

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“…Swallowing dysfunction (i.e. dysphagia) is common in acute stroke and patients with more severe stroke are more likely to present with dysphagia [1,42]. In the present study, pharyngeal acidity was inversely correlated to dysphagia severity indicating that patients with more severe dysphagia presented the highest pharyngeal acidity levels.…”

Section: Discussionsupporting

confidence: 47%

A Preliminary Investigation of Relationships among Pharyngeal Acidity, Dysphagia, and Pneumonia in Acute Stroke

Madhavan¹,

Sia²,

Carnaby³

et al. 2021

OBM Geriatrics

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Individuals with acute stroke on nonoral feeding regimens frequently develop pneumonia, questioning the long-held belief that pneumonia in stroke patients is a caused by food and liquid aspiration alone. Refluxate and colonized oral secretions are thought to contribute to an acidic oropharyngeal environment. If aspirated, these colonized oral secretions with increased acidity, can result in increased risk to the respiratory system. This study aimed to investigate the relationship between pharyngeal acidity, dysphagia, and pneumonia in acute stroke patients. Twenty-one patients (mean age 67 years) admitted to a stroke unit were recruited into this study. We evaluated their stroke and dysphagia severity via clinical measures. Pharyngeal acidity was measured using a Restech Dx-pH measurement probe placed transnasally for 24 hours. Sixty two (62%) patients presented with moderate to severe stroke and 38% with dysphagia. Seven patients (33%) were positive for pharyngeal acidity. Two patients with pharyngeal acidity were diagnosed with chest infection. Pharyngeal acidity was significantly correlated with stroke severity (r = 0.487, P = 0.03) and significantly and inversely correlated to clinical swallow performance (rho = -0.626, p = 0.02). Additionally, pharyngeal acidity was significantly associated with categorical dysphagia scores (c2(3,21) = 10.5, p<0.01), functional oral intake (c2(3,21) = 15.7, p<0.001), presence of modified diets (χ2(1,21) = 14.0, p=0.0001), and tube feeding (χ2 (1,21) = 9.992, p = 0.002). Preliminary results suggest that acute stroke patients with dysphagia may present with increased risk for increased pharyngeal acidity. Pharyngeal acidity can result in negative sequelea, including respiratory complications. A better understanding of these potential relationships may lead to enhanced assessment and treatment approaches that limit pharyngeal acidity and resulting respiratory complications in acute stroke patients.

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Section: Discussionsupporting

confidence: 47%

A Preliminary Investigation of Relationships among Pharyngeal Acidity, Dysphagia, and Pneumonia in Acute Stroke

Madhavan¹,

Sia²,

Carnaby³

et al. 2021

OBM Geriatrics

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“…In this connection, we observed that patients who developed pneumonia were more complicated subjects from a neurological standpoint, although only in 1 case (12.5%) was the cause attributed to ab ingestis problems, notwithstanding the high percentage of dysphagic subjects in artificial enteric feeding via NG and PEG tubes. Note that, in the literature, the problem of dysphagia in acute patients following stroke affects between 13% and 94% of subjects [35] and is responsible for between 17% and 60% of respiratory complications in acute settings [11,12,36].…”

Section: Original Articlementioning

confidence: 99%

Monitoring of hospital acquired pneumonia in patients with severe brain injury on first access to intensive neurological rehabilitation: First year of observation

Beghi¹,

Tanti²,

Serafini³

et al. 2018

Monaldi Arch Chest Dis

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Nosocomial or hospital acquired pneumonia (HAP) is an illness contracted during a hospital stay, generally with onset 48 hours or more after admission to hospital, or within 14 days of discharge from hospital. HAP is divided into subgroups: Ventilator-associated pneumonia (VAP), accounting for 86% of hospital acquired pneumonia, and stroke-associated pneumonia (SAP). The incidence of SAP in neurological intensive care units (NICUs) is 4.1-56.6%, in medical intensive care units (MICUs) it is 17-50%, in stroke units it is 3.9-44% and in rehabilitation it is 3.2-11%, whereas in intensive rehabilitation following severe cranial trauma, the reported incidence of HAP is between 3.9 and 12% of cases. The aim of this study is to evaluate the cases of HAP occurring in a continuous series of patients with severe acquired brain injury (sABI) admitted to intensive rehabilitation units. The data collected can help evaluate the growing complexity of early rehabilitation of these patients, starting from how lung infections interfere with hospital stays and rehabilitation outcomes. This prospective observational cohort study evaluates, from 01/01/2015 to 31/12/2015, for patients with sABI on first admission to intensive neurological rehabilitation, the frequency of HAP and its impact on patient outcomes and complexity of care. A total of 61 patients were enrolled: 39 males and 22 females, average age 59.5 years (17-88 yrs, SD 3.53), coming from critical care (n=52), medical units (n=5), neurosurgery (n=3) and surgical units (n=1). The aetiology of hospital admission was haemorrhagic in 36% of cases, traumatic in 36%, anoxic in 13.1%, infectious in 6.5%, ischaemic in 4.9%, and other causes in 3.2%. Among the patients, 93.44% had received antibiotic therapy in their unit of provenance, and in 61.27% of cases a multidrug resistant (MDR) bacterium was isolated. On enrolment, 26 patients presented respiratory insufficiency, 29 subjects were in oxygen therapy, and 4 under invasive mechanical ventilation. There were 54 tracheostomized patients, 33 patients with percutaneous endoscopic gastrostomy (PEG) tubes, and 23 with nasogastric (NG) tubes. In 2015, among these subjects admitted to neurological rehabilitation, the incidence of HAP was 13.1%. For these 8 pneumonia cases, it was possible to isolate the bacterium in 62.5% of cases, and the detected microorganisms were K. pneumoniae (n=2), P. aeruginosa (n=1), P. mirabilis (n=1), S. maltophilia (n=1), E. cloacae + MRSCoN (n=1). Compared to the literature data, the results of the first year of monitoring show a slight increase in HAP cases (13.1%) in severe brain injury patients on first admission to neurological rehabilitation. These preliminary results need to be further confirmed and monitored over time. The findings moreover confirm the criticality and complexity of care for these patients admitted to neurological rehabilitation units.

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“…The factors that can negatively affect outcomes after stroke include age, stroke characteristics, and related complications [2][3][4], such as poststroke oropharyngeal dysphagia, which is defined as the presence of abnormal swallowing physiology in the upper aerodigestive tract [5]. Poststroke oropharyngeal dysphagia is associated with poor outcomes, such as institutionalization [4], dehydration [6], malnutrition [6,7], pneumonia [7,8], decreased functional independence [4], increased mortality and morbidity [1,7], increased length of stay in hospital [9], and increased healthcare costs [10]. Poststroke pneumonia has multifactorial etiology [11][12][13], of which oropharyngeal dysphagia is a significant factor, which leads to the aspiration of colonized oropharyngeal material such as liquids, foods, and oral secretions [7,8,11,12].…”

Section: Introductionmentioning

confidence: 99%

Concurrent and Predictive Validity of the Mann Assessment of Swallowing Ability in Belgian Acute Stroke Patients Based on a 1-Year Follow-Up Study

Simpelaere,

Hansen,

Roelant

et al. 2023

Folia Phoniatr Logop

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Introduction: The Mann Assessment of Swallowing Ability (MASA) is a standardized clinical swallowing examination, specifically developed as a diagnostic test for the presence of oropharyngeal dysphagia and aspiration in the early period after stroke onset. In the original validation study, cutoff scores of <178 and <170 points, respectively, for the identification of dysphagia and aspiration risk are reported. However, a literature search revealed that alternative cutoff scores for dysphagia and/or aspiration provide better diagnostic accuracy. The aim of this secondary data analysis study was to evaluate the concurrent and predictive validity of the MASA. Methods: Data were derived from a Belgian cohort study of an acute stroke population (n = 151). The MASA total score (MASA-TS), which is the sum of weighted scores on the 24 items, was evaluated against the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) to assess concurrent validity. To assess predictive validity of the MASA-TS, pneumonia during hospitalization and over 1 year and mortality acted as a future criterion. Analyses included receiver operating characteristic curves and area under the curve (AUC). Results: Diagnostic accuracy of the MASA-TS was good for dysphagia (AUC = 0.85) and for the presence of relevant aspiration risk (AUC = 0.84). Using the original cutoff scores, the MASA-TS showed perfect sensitivity (Se = 1.00) for the identification of dysphagia and aspiration but inadequate specificity (Sp) for dysphagia (Sp = 0.16) and aspiration (Sp = 0.43). After determining new MASA cutoff scores, the optimal MASA cutoff scores were ≤146 for both dysphagia and aspiration with adequate thresholds (Se = 0.71 and Sp = 0.81 for dysphagia; Se = 0.73 and Sp = 0.80 for aspiration). The MASA-TS was a significant predictor of pneumonia during hospitalization (AUC = 0.85) and 1-year follow-up (AUC = 0.86), and of mortality (AUC = 0.79). Conclusion: The MASA-TS showed good concurrent validity with the FEDSS. Furthermore, using new cutoff scores (≤146 for the identification of dysphagia and aspiration) lead in general to more accurate diagnostic indexes. The MASA-TS is a good predictor of aspiration pneumonia during hospitalization and 1-year follow-up and of mortality.

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Dysphagia and Respiratory Infections in Acute Ischemic Stroke

Cited by 4 publications

References 70 publications

A Preliminary Investigation of Relationships among Pharyngeal Acidity, Dysphagia, and Pneumonia in Acute Stroke

A Preliminary Investigation of Relationships among Pharyngeal Acidity, Dysphagia, and Pneumonia in Acute Stroke

Monitoring of hospital acquired pneumonia in patients with severe brain injury on first access to intensive neurological rehabilitation: First year of observation

Concurrent and Predictive Validity of the Mann Assessment of Swallowing Ability in Belgian Acute Stroke Patients Based on a 1-Year Follow-Up Study

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