Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review
- PDF / 638,134 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 86 Downloads / 203 Views
REVIEW
Factors Associated with Risk of Stroke‑Associated Pneumonia in Patients with Dysphagia: A Systematic Review Sabrina A. Eltringham1,2 · Karen Kilner2 · Melanie Gee2 · Karen Sage2 · Ben D. Bray3 · Craig J. Smith4,5 · Sue Pownall1,2 Received: 13 November 2018 / Accepted: 27 August 2019 © The Author(s) 2019
Abstract 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 I2. 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. Keywords Deglutition · Deglutition disorders · Dysphagia · Stroke-associated pneumonia · Stroke · Risk factors
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00455-019-10061-6) contains supplementary material, which is available to authorized users. * Sabrina A. Eltringham [email protected] 1
Speech and Language Therapy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
2
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
3
King’s College London, London, UK
4
Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Manchester, UK
5
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
Stroke-Associated Pneumonia (SAP) is common post stroke affecting 14% of patients [1], and is associated with increased risk of in hospital mortality [
Data Loading...
