The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study

Schwarz, Maria; Coccetti, Anne; Murdoch, Allison; Cardell, Elizabeth

doi:10.1111/jocn.13922

Cited by 42 publications

(33 citation statements)

References 45 publications

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“…Kalra et al [31] and Kalra et al [32] used the same RCT data. Study designs included RCTs (30%) [15,[31][32][33], prospective (20%) [13,34] and retrospective (40%) [35][36][37][38] observational studies and one quasi-experimental design [39]. Europe hosted 55% of studies [15,[31][32][33][34]37], Australia 27% [13,36,38] and Japan 18% [35,39].…”

Section: Resultsmentioning

confidence: 99%

“…Warusevitaine et al [15] and Langdon et al [13] reported at 21 days and 30 days, respectively. Schwarz et al [38] did not report the period of diagnosis. Marked variation in study design and reporting of participant characteristics prohibited meta-analysis.…”

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 98%

“…Preventive antibiotics did not reduce incidence of SAP in patients with NGT [aOR 1.05 (95% CI 0.73-1.52); p = 0.803]. Schwartz et al [38] did not report incidence of SAP in patients with NGT and did not respond to information requests by the author. Differences in SAP incidence between studies can be partly explained by the different study populations and the lack of adjustment for stroke severity and baseline characteristics [13,36].…”

Section: Prophylactic Measuresmentioning

confidence: 98%

“…Four used a combination of clinical symptoms, radiologic findings on X-ray and laboratory results and combined antibiotics [13,15,33,37]. Two studies provided no definition [36,38].…”

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 99%

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Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

et al. 2019

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Dysphagia is associated with increased risk of stroke-associated pneumonia (SAP). However, it is unclear what other factors contribute to that risk or which measures may reduce it. This systematic review aimed to provide evidence on interventions and care processes associated with SAP in patients with dysphagia. Studies were screened for inclusion if they included dysphagia only patients, dysphagia and non-dysphagia patients or unselected patients that included dysphagic patients and evaluated factors associated with a recorded frequency of SAP. Electronic databases were searched from inception to February 2017. Eligible studies were critically appraised. Heterogeneity was evaluated using I 2. The primary outcome was SAP. Eleven studies were included. Sample sizes ranged from 60 to 1088 patients. There was heterogeneity in study design. Measures of immunodepression are associated with SAP in dysphagic patients. There is insufficient evidence to justify screening for aerobic Gram-negative bacteria. Prophylactic antibiotics did not prevent SAP and proton pump inhibitors may increase risk. Treatment with metoclopramide may reduce SAP risk. Evidence that nasogastric tube (NGT) placement increases risk of SAP is equivocal. A multidisciplinary team approach and instrumental assessment of swallowing may reduce risk of pneumonia. Patients with impaired mobility were associated with increased risk. Findings should be interpreted with caution given the number of studies, heterogeneity and descriptive analyses. Several medical interventions and care processes, which may reduce risk of SAP in patients with dysphagia, have been identified. Further research is needed to evaluate the role of these interventions and care processes in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 98%

Section: Prophylactic Measuresmentioning

confidence: 98%

“…Four used a combination of clinical symptoms, radiologic findings on X-ray and laboratory results and combined antibiotics [13,15,33,37]. Two studies provided no definition [36,38].…”

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 99%

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Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

et al. 2019

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“…Various mechanisms underlying the development of SAP have been identi ed, in addition to stroke-induced immunosuppression, dysphagia, poor respiratory muscle strength, decreased pulmonary function and respiratory center dysfunction after brain injury also play important roles [5][6][7][8][9][10]. Among them, oral hygiene is often overlooked.…”

Section: Introductionmentioning

confidence: 99%

Mutually Risk Roles of Oral Cleanliness and Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke: A Cross-Sectional Study

Yang

Chen

Yang

et al. 2020

Preprint

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Background: Stroke-associated pneumonia (SAP) is a major complication after stroke, oral microorganisms are important contributors to SAP. Here, we aimed to investigate whether the oral hygiene was associated with SAP and related risk factors of them in patients with acute ischemic stroke. Methods: We performed a cross-sectional study that recruited 331 patients with acute ischemic stroke from two medical centers. A series of assessments were performed to evaluate the neurological status and habits of oral hygiene. According to whether the oral hygiene was abnormal and SAP occurred, univariate analyses were performed in cohort 1 (normal / abnormal oral hygiene groups) and cohort 2 (SAP / non-SAP groups). Multiple logistic regression analyses were conducted to confirm risk factors of oral cleanliness and SAP in stroke patients. Results: A total of 12 and 8 independent variables were included in the model 1 and 2 analysis. After adjusting for confounders, multivariable logistic regression analysis showed that oral cleanliness was not only closely related to SAP (OR=2.219, P=0.026), dental caries (OR=1.292, P=0.005) and age (OR=1.030, P=0.006) in model 1, but also an independent risk factor for predicting SAP (OR=1.678, P=0.001) in model 2. Barthel index was a protective factor for oral cleanliness (OR=0.986, P=0.019) and SAP (OR=0.977, P=0.002) in ischemic stroke patients. Conclusions: Mutually primary risk roles of abnormal oral cleanliness and SAP exist in patients with acute ischemic stroke. Dental caries and aging are important risk factors for oral health disorders. Improving the activities of daily living would have protective effects on both oral hygiene and SAP prevention in stroke patients.

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Durch neurologische Erkrankungen bedingte Dysphagien

Kalitzky¹,

Nienstedt²,

Pflug³

2023

HNO Nachrichten

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The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study

Abstract: Aims and objectives: To determine presence of clinical complications related to dysphagia and to explore their operational outcomes.Background: Dysphagia is a common complication of stroke. The management of

Cited by 42 publications

References 45 publications

Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

Mutually Risk Roles of Oral Cleanliness and Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke: A Cross-Sectional Study

Durch neurologische Erkrankungen bedingte Dysphagien

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