Mortality and Cost of Pneumonia After Stroke for Different Risk Groups

Wilson, Richard D.

doi:10.1016/j.jstrokecerebrovasdis.2010.05.002

Cited by 145 publications

(121 citation statements)

References 24 publications

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“…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: Definitions and General Termsmentioning

confidence: 99%

“…Post-stroke pneumonia also increases the financial burden on the medical system. The annual cost of this complication approaches USD 459 million [4] and the average marginal cost of hospitalization is USD 27,633 [5]. These factors reflect the importance of preventing this complication.…”

Section: Introductionmentioning

confidence: 99%

Stroke-Associated Pneumonia: Major Advances and Obstacles

et al. 2013

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“…Other studies have demonstrated that stroke-induced immune suppression increases the risk of secondary infections and increases mortality rates in patients [16,17]. Up to 65 % of patients with stroke suffer from pneumonia and urinary tract infections [18,19], and approximately 30 % of them die from stroke-related infections [20][21][22]. Studies focusing on the innate immune system have shown that stroke impairs the respiratory burst and subsequent generation of inflammatory mediators in granulocytes and monocytes [23,24].…”

Section: Impact Of Stroke On Immunitymentioning

confidence: 99%

Microglia and Monocyte-Derived Macrophages in Stroke

2016

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Historically, the brain has been considered an immune-privileged organ separated from the peripheral immune system by the blood-brain barrier. However, immune responses do occur in the brain in neurological conditions in which the integrity of the blood-brain barrier is compromised, exposing the brain to peripheral antigens and endogenous danger signals. While most of the associated pathological processes occur in the central nervous system, it is now clear that peripheral immune cells, especially mononuclear phagocytes, that infiltrate into the injury site play a key role in modulating the progression of primary brain injury development. As inflammation is a necessary and critical component for the subsequent injury resolution process, understanding the contribution of mononuclear phagocytes on the regulation of inflammatory responses may provide novel approaches for potential therapies. Furthermore, predisposed comorbid conditions at the time of stroke cause the alteration of stroke-induced immune and inflammatory responses and subsequently influence stroke outcome. In this review, we summarize a role for microglia and monocytes/macrophages in acute ischemic stroke in the context of normal and metabolically compromised conditions.

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“…1,2 Cerebrovascular diseases or stroke is the third most frequent cause of death in developed countries, only after heart disease and cancer. 3 It has been observed that subjects who have had a cerebrovascular accident have weak respiratory muscles.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Inspiratory Muscle Training After Cerebrovascular Accident

Martín-Valero¹,

de-la-Casa-Almeida²,

Casuso-Holgado³

et al. 2015

Respir Care

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Only 6 studies were relevant to this review. Three different types of interventions were found (maximum inspiratory training, controlled training, and nonintervention) in 3 different groups. One specific study compared 3 inspiratory muscle training groups with a group of breathing exercises (diaphragmatic exercises with pursed lips) and a control group. Future long-term studies with larger sample sizes are needed. It is necessary to apply respiratory muscle training as a service of the national health system and to consider its inclusion in the conventional neurological program.

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Mortality and Cost of Pneumonia After Stroke for Different Risk Groups

Cited by 145 publications

References 24 publications

Stroke-Associated Pneumonia: Major Advances and Obstacles

Stroke-Associated Pneumonia: Major Advances and Obstacles

Microglia and Monocyte-Derived Macrophages in Stroke

Systematic Review of Inspiratory Muscle Training After Cerebrovascular Accident

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