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Open Access 01-10-2020 | Stroke | Review

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

Authors: Sabrina A. Eltringham, Karen Kilner, Melanie Gee, Karen Sage, Ben D. Bray, Craig J. Smith, Sue Pownall

Published in: Dysphagia | Issue 5/2020

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.

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Title: Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review
Authors: Sabrina A. Eltringham
Karen Kilner
Melanie Gee
Karen Sage
Ben D. Bray
Craig J. Smith
Sue Pownall
Publication date: 01-10-2020
Publisher: Springer US
Keywords: Stroke
Pneumonia
Dysphagia
Dysphagia
Dysphagia
Published in: Dysphagia / Issue 5/2020
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-019-10061-6

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

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