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Published in: BMC Neurology 1/2017

Open Access 01-12-2017 | Research article

Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program

Authors: Belma Doğan Güngen, Abdulkadir Tunç, Yeşim Güzey Aras, Aslı Aksoy Gündoğdu, Adil Can Güngen, Serdar Bal

Published in: BMC Neurology | Issue 1/2017

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Abstract

Background

The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients.

Methods

This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group.

Results

Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (p<0.001; r=0.440, r=0.432, r=0.339 and r=0.410, respectively). One and three months mortality- ICU admission had a statistically significant relationship with parenteral nutrition (p<0.001; r=0.346, r=0.300, respectively; r=0.294 and r=0.294, respectively). Similarly, there was also a statistically significant relationship between pneumonia onset and one- and three-month mortality- ICU admission (p<0.05; r=0.217, r=0.127, r=0.185 and r=0.185, respectively). A regression analysis showed that parenteral nutrition (odds ratio [OR] =13.434, 95% confidence interval [CI] =1.148–157.265, p=0.038) was a significant predictor of ICU admission. The relationship between pulmonary physiotherapy (PPT) and ICU admission- pneumonia onset at the end of three months was statistically significant (p=0.04 and p=0.043, respectively).

Conclusion

This study showed that PPT improved the prognosis of ischemic stroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes.

Trial registration

NCT03195907. Trial registration date: 21.06.2017 ‘Retrospectively registered’.
Literature
1.
go back to reference Ariza-Vega P, Lozano-Lozano M, Olmedo-Requena R, Martín-Martín L, Jiménez-Moleón JJ. Influence of cognitive impairment on mobility recovery of patients with hip fracture. Am J Phys Med Rehabil. 2016;8(9):e75719. Ariza-Vega P, Lozano-Lozano M, Olmedo-Requena R, Martín-Martín L, Jiménez-Moleón JJ. Influence of cognitive impairment on mobility recovery of patients with hip fracture. Am J Phys Med Rehabil. 2016;8(9):e75719.
2.
go back to reference Nakibuuka J, Sajatovic M, Nankabirwa J, et al. Early mortality and functional outcome after acute stroke in Uganda: prospective study with 30 day follow-up. Spring. 2015;4:450.CrossRef Nakibuuka J, Sajatovic M, Nankabirwa J, et al. Early mortality and functional outcome after acute stroke in Uganda: prospective study with 30 day follow-up. Spring. 2015;4:450.CrossRef
3.
go back to reference Mackay-Lyons MJ, Makrides L. Exercise capacity early after stroke. Arch Phys Med Rehabil. 2002;83:1697–702.CrossRefPubMed Mackay-Lyons MJ, Makrides L. Exercise capacity early after stroke. Arch Phys Med Rehabil. 2002;83:1697–702.CrossRefPubMed
4.
go back to reference Joo S, Shin D, Song C. The effects of game-based breathing exercise on pulmonary function in stroke patients: A Preliminary Study. Med Sci Monit. 2015;21:1806–11.CrossRefPubMedPubMedCentral Joo S, Shin D, Song C. The effects of game-based breathing exercise on pulmonary function in stroke patients: A Preliminary Study. Med Sci Monit. 2015;21:1806–11.CrossRefPubMedPubMedCentral
5.
go back to reference Teixeira-Salmela LF, Parreira VF, Britto RR, et al. Respiratory pressures and thoracoabdominal motion in community-dwelling chronic stroke survivors. Arch Phys Med Rehabil. 2005;86:1974–8.CrossRefPubMed Teixeira-Salmela LF, Parreira VF, Britto RR, et al. Respiratory pressures and thoracoabdominal motion in community-dwelling chronic stroke survivors. Arch Phys Med Rehabil. 2005;86:1974–8.CrossRefPubMed
6.
go back to reference Hill K, Jenkins SC, Philippe DL, et al. Comparison of incremental and constant load tests of inspiratory muscle endurance in COPD. Eur Respir J. 2007;30:479–86.CrossRefPubMed Hill K, Jenkins SC, Philippe DL, et al. Comparison of incremental and constant load tests of inspiratory muscle endurance in COPD. Eur Respir J. 2007;30:479–86.CrossRefPubMed
7.
go back to reference Mador MJ, Deniz O, Aggarwal A, et al. Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation. Chest. 2005;128:1216–24.CrossRefPubMed Mador MJ, Deniz O, Aggarwal A, et al. Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation. Chest. 2005;128:1216–24.CrossRefPubMed
8.
go back to reference McCool FD, Tzelepis GE. Inspiratory muscle training in the patient with neuromuscular disease. Phys Ther. 1995;75:1006–14.CrossRefPubMed McCool FD, Tzelepis GE. Inspiratory muscle training in the patient with neuromuscular disease. Phys Ther. 1995;75:1006–14.CrossRefPubMed
9.
go back to reference Seo K, Hwan PS, Park K. The effects of inspiratory diaphragm breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke patients’ respiratory muscle activation. J Phys Ther Sci. 2017;29(3):465–9.CrossRefPubMedPubMedCentral Seo K, Hwan PS, Park K. The effects of inspiratory diaphragm breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke patients’ respiratory muscle activation. J Phys Ther Sci. 2017;29(3):465–9.CrossRefPubMedPubMedCentral
10.
go back to reference Lan MY, Wu SJ, Chang YY, Chen WH, Lai SL, Liu JS. Neurologic and non-neurologic predictors of mortality in ischemic stroke patients admitted to the intensive care unit. J Formos Med Assoc. 2006;105(8):653–8.CrossRefPubMed Lan MY, Wu SJ, Chang YY, Chen WH, Lai SL, Liu JS. Neurologic and non-neurologic predictors of mortality in ischemic stroke patients admitted to the intensive care unit. J Formos Med Assoc. 2006;105(8):653–8.CrossRefPubMed
11.
go back to reference Rankin J. Cerebral vascular accidents in patients over the age of 60. I General considerations Scott Med J. 1957;2:127–36.CrossRefPubMed Rankin J. Cerebral vascular accidents in patients over the age of 60. I General considerations Scott Med J. 1957;2:127–36.CrossRefPubMed
12.
go back to reference Kolominsky-Rabas PL, Weber M, Gefeller O, et al. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001;32:2735–40.CrossRefPubMed Kolominsky-Rabas PL, Weber M, Gefeller O, et al. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001;32:2735–40.CrossRefPubMed
13.
go back to reference Jauch EC, Saver JL, Adams HP Jr, et al. American Heart Association Stroke Council, Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.CrossRefPubMed Jauch EC, Saver JL, Adams HP Jr, et al. American Heart Association Stroke Council, Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.CrossRefPubMed
14.
go back to reference Li Z, Wang Y, Zhao X, et al. Treatment effect of clopidogrel plus aspirin within 12 hours of acute minor stroke or transient ischemic attack. J Am Heart Assoc. 2016;5(3):e003038.CrossRefPubMedPubMedCentral Li Z, Wang Y, Zhao X, et al. Treatment effect of clopidogrel plus aspirin within 12 hours of acute minor stroke or transient ischemic attack. J Am Heart Assoc. 2016;5(3):e003038.CrossRefPubMedPubMedCentral
15.
go back to reference Seo KC, Lee HM, Kim HA. The effects of combination of inspiratory diaphragm exercise and expiratory pursed-lip breathing exercise on pulmonary functions of stroke patients. J Phys Ther Sci. 2013;25:241–4.CrossRef Seo KC, Lee HM, Kim HA. The effects of combination of inspiratory diaphragm exercise and expiratory pursed-lip breathing exercise on pulmonary functions of stroke patients. J Phys Ther Sci. 2013;25:241–4.CrossRef
16.
go back to reference Heuschmann PU, Wiedmann S, Wellwood I, et al. Three-month stroke outcome: the European Registers of Stroke (EROS) investigators. Neurology. 2011;76:159–65.CrossRefPubMed Heuschmann PU, Wiedmann S, Wellwood I, et al. Three-month stroke outcome: the European Registers of Stroke (EROS) investigators. Neurology. 2011;76:159–65.CrossRefPubMed
17.
go back to reference Grube MM, Koennecke HC, Walter G, et al. Berlin Stroke Register (BSR). Influence of acute complications on outcome 3 months after ischemic stroke. PLoS One. 2013;8(9):e75719.CrossRefPubMedPubMedCentral Grube MM, Koennecke HC, Walter G, et al. Berlin Stroke Register (BSR). Influence of acute complications on outcome 3 months after ischemic stroke. PLoS One. 2013;8(9):e75719.CrossRefPubMedPubMedCentral
18.
go back to reference Golestanian E, Liou JI, Smith MA. Long-term survival in older critically ill patients with acute ischemic stroke. Crit Care Med. 2009;37(12):3107–13.CrossRefPubMedPubMedCentral Golestanian E, Liou JI, Smith MA. Long-term survival in older critically ill patients with acute ischemic stroke. Crit Care Med. 2009;37(12):3107–13.CrossRefPubMedPubMedCentral
19.
go back to reference Poudel RS, Thapa LJ, Shrestha S, et al. Efficacy of combined antithrombotic, statin and antihypertensive agents in acute ischemic stroke. J Nepal Med Assoc. 2015;53(197):5–11. Poudel RS, Thapa LJ, Shrestha S, et al. Efficacy of combined antithrombotic, statin and antihypertensive agents in acute ischemic stroke. J Nepal Med Assoc. 2015;53(197):5–11.
20.
go back to reference Dewan KR, Rana PV. A study of seven day mortality in acute ischemic stroke in a teaching hospital in Chitwan. J Nepal Health Res Counc. 2014;12(26):33–8.PubMed Dewan KR, Rana PV. A study of seven day mortality in acute ischemic stroke in a teaching hospital in Chitwan. J Nepal Health Res Counc. 2014;12(26):33–8.PubMed
21.
go back to reference Pinto G, Zétola V, Lange M, et al. Program to diagnose probability of aspiration pneumonia in patients with ischemic stroke. Int Arch Otorhinolaryngol. 2014;18(3):244–8.CrossRefPubMedPubMedCentral Pinto G, Zétola V, Lange M, et al. Program to diagnose probability of aspiration pneumonia in patients with ischemic stroke. Int Arch Otorhinolaryngol. 2014;18(3):244–8.CrossRefPubMedPubMedCentral
22.
go back to reference Koennecke HC, Belz W, Berfelde D, et al. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology. 2011;77:965–72.CrossRefPubMed Koennecke HC, Belz W, Berfelde D, et al. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology. 2011;77:965–72.CrossRefPubMed
23.
go back to reference Kim J, Park JH, Yim J. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit. 2014;20:2543–9.CrossRefPubMedPubMedCentral Kim J, Park JH, Yim J. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit. 2014;20:2543–9.CrossRefPubMedPubMedCentral
24.
go back to reference Sutbeyaz ST, Koseoglu F, Inan L, et al. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil. 2010;24(3):240–50.CrossRefPubMed Sutbeyaz ST, Koseoglu F, Inan L, et al. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil. 2010;24(3):240–50.CrossRefPubMed
25.
go back to reference Katz-Leurer M, Shochina M, Carmeli E, et al. The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage. Arch Phys Med Rehabil. 2003;84(11):1609–14.CrossRefPubMed Katz-Leurer M, Shochina M, Carmeli E, et al. The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage. Arch Phys Med Rehabil. 2003;84(11):1609–14.CrossRefPubMed
Metadata
Title
Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program
Authors
Belma Doğan Güngen
Abdulkadir Tunç
Yeşim Güzey Aras
Aslı Aksoy Gündoğdu
Adil Can Güngen
Serdar Bal
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2017
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-017-0912-4

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