Pneumonia in acute stroke patients fed by nasogastric tube

Dziewas, Rainer; Ritter, Martin; Schilling, Matthias; Konrad, Carsten; Oelenberg, Stephan; Nabavi, Darius G.; Stögbauer, Florian; Ringelstein, E. B.; Lüdemann, Peter

doi:10.1136/jnnp.2003.019075

Cited by 199 publications

(180 citation statements)

References 41 publications

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“…It was observed that a significant increase in the activation of the sensorimotor cortex occurs on the left compared to the right during swallowing (8) . However, most studies report that patients with lesions in the right hemisphere have more swallowing dysfunction (44) .…”

Section: Discussionmentioning

confidence: 94%

Risk factors for swallowing dysfunction in stroke patients

Baroni

Fábio

Dantas

2012

Arq. Gastroenterol.

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-Context -Stroke is a frequent cause of dysphagia. Objective -To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. Methods -Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. Results -It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. Conclusions -Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death. HEADINGS -Stroke. Deglutition disorders.

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Section: Discussionmentioning

confidence: 94%

Risk factors for swallowing dysfunction in stroke patients

Baroni

Fábio

Dantas

2012

Arq. Gastroenterol.

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“…[5] Stroke severity as measured using the National Institute of Health Stroke Scale (NIHSS) score is the only factor associated with pneumonia, [1] and is a predictor of poor outcome. [6] The increasing length of stay (>5 h) at the emergency department was found to worsen the neurologic outcome but not mortality. [7] Pneumonia has been one of the top causes of mortality in acute stroke patients in our institution over the years.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Castillo¹,

Sumalapao²,

Pascual³

2017

Natl J Physiol Pharm Pharmacol

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Background: Knowledge on the risk factors of developing pneumonia, one of the top causes of mortality in acute stroke patients admitted to a tertiary government hospital, is lacking. Aim and Objective: This study aimed to determine the factors associated with the risk of developing pneumonia in acute stroke patients admitted to the emergency department of a tertiary government hospital. Materials and Methods: A retrospective matched case-control study involving acute stroke patients admitted to the emergency department of a tertiary government hospital with 168 pneumonia patients matched with 168 controls by sex was employed. Age, sex, vascular risk factors, previous hospitalization within the past 3 months, type and location of stroke, need for intubation, length of hospital emergency room stay, National Institute of Health Stroke Scale (NIHSS) score on admission, pre-morbid Modified Rankin Scale (mRS) score, and outcome (mortality, NIHSS score and mRS score at discharge) were obtained from the medical charts. Odds ratios were calculated using a multivariate logistic regression analysis. Among stroke patients developing pneumonia, the type of pneumonia and microorganisms were identified. Results: Smoking, alcohol intake, dysphagia, hemorrhagic stroke, need for intubation, and age were associated with pneumonia. Pneumonia increases the odds of mortality and disability by 14 and 7 times, respectively. Hospital-acquired pneumonia is the most common type with Acinetobacter baumanii and Klebsiella pneumonia as the most common microorganisms identified. Conclusion: Age, alcohol intake, dysphagia, hemorrhagic stroke, and need for intubation increase the risk for post-stroke pneumonia with organisms isolated consistent with nosocomial pneumonia.

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“…Studies regarding the effects of infection on worsening stroke symptoms have yielded ambiguous results [14]. While several studies could not demonstrate an independent association between infection and worsening of neurological deficit after stroke [15][16][17], the majority of studies showed that infections in hospitalized patients in the acute phase after stroke are associated with a worse functional outcome and increased mortality [6,[18][19][20]. In the largest study, Katzan et al [21] described a 30-day mortality of 27 % after poststroke pneumonia compared with a mortality rate of 4 % in patients without pneumonia.…”

Section: Rationale Behind Prophylactic Antibiotic Therapy In Strokementioning

confidence: 99%

Prophylactic Antibiotic Therapy for Preventing Poststroke Infection

Schwarz

2016

Neurotherapeutics

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Infections, in particular pneumonia, are common complications in patients with acute stroke and are associated with a less favorable neurologic and functional outcome. Patients with severe stroke and dysphagia are at highest risk of infection. Experimental and clinical data suggest stroke-induced immunodeficiency as a major factor contributing to the high incidence of infection after stroke. Preclinical studies support the potential benefit of preventive antibiotic therapy in acute stroke for lowering the incidence of infection and improving clinical outcome. Several smaller clinical trials on preventive antibiotic therapy in patients with stroke conducted during the last 10 years yielded inconclusive results. Recently, 2 large, open-label, controlled trials failed to demonstrate an improved clinical outcome after preventive antibiotic therapy in patients with acute stroke treated in specialized stroke units. In the BPreventive Antibiotics in Stroke Study^, antibiotic therapy lowered the rate of infection but did not influence outcome. In the STROKE-INF study, performed in patients with dysphagia after stroke, antibiotic therapy did not lower the incidence of pneumonia and had no prognostic significance. At present, preventive antibiotic therapy cannot be recommended as a therapeutic option for acute stroke.

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Pneumonia in acute stroke patients fed by nasogastric tube

Cited by 199 publications

References 41 publications

Risk factors for swallowing dysfunction in stroke patients

Risk factors for swallowing dysfunction in stroke patients

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Prophylactic Antibiotic Therapy for Preventing Poststroke Infection

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