REVIEW PAPER
Post-stroke management research in the light of a rehabilitation scheme aimed at reducing the risk of developing pneumonia
 
More details
Hide details
1
Fitness Club Olimpia Lublin, Poland
 
2
Pope John Paul II State School of Higher Education, Biała Podlaska, Poland
 
3
Ternopil State Medical University, Ukraine
 
 
Corresponding author
Milena Socha   

Fitness Club Olimpia Lublin, Jana Skrzetuskiego 6/79, 20-628 Lublin, Poland
 
 
J Pre Clin Clin Res. 2018;12(1):1-5
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Pneumonia is one of the most common infectious complications among people after stroke. The presence of this complication is associated with a significant increase in mortality and a deterioration in the clinical condition of the patients resulting in a longer hospitalization time and more severe rehabilitation, which translates into worse functional status.

Objective:
The aim of the study is to analyze the causes and consequences of development of pneumonia in early poststroke rehabilitation and to indicate the need for modification of rehabilitation methods at the onset of infection.

Description of the state of knowledge:
In the literature describing infections found in neurological departments and intensive care, the concept of Stroke-associated pneumonia (SAP) is believed to be associated with pneumonia. Risk factors in this situation are disturbances of consciousness and dysphagia, and it is assumed that this condition is associated with abnormal dopamine transmission in patients after extensive stroke.

Conclusions:
In the early post-stroke period, there are numerous predictors of pneumonia: dysphagia, decrease in P levels, cough reflex, adverse bacterial flora development, postprandial immunodepression, mechanical ventilation and hypokinesia, which allow early identification of patients particularly at risk. the risk of disease development and the use of appropriate measures. On the one hand, it points to the need to develop a variety of measures to minimize the risk of developing pneumonia and to rapidly develop new standards of management to improve upon the onset of pneumonia so as to reduce the consequences of infection

 
REFERENCES (44)
1.
Golik VA, Husk AP. Motor Rehab after Stroke. Math. Of Sciences. Practice. Conf. "Carpathian readings": theses of additional. Uzhgorod 2009: 7–8.
 
2.
Westendorp WF, Nederkoorn PJ, Vermeij JD, Dijkgraaf MG, van de Beek D. Post-stroke infection: A systematic review and meta-analysis Westendorp et al. BMC Neurology 2011; 11: 110.
 
3.
Grabowska-Fudula B, Jaracz K, Górna K. Zapadalność, śmiertelność i umieralność z powodu udarów mózgu – aktualne tendencje i prognozy na przyszłość. Prz Epidemiol. 2010; 64: 439–442.
 
4.
Hannawi Y, Hannawi B, Rao CP, Suarez JI, Bershad EM. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013; 35(5): 430–43.
 
5.
Teramoto S. Novel preventive and therapuetic strategy for post-stroke pneumonia. Expert Rev Neurother. 2009; 9: 1187–1200.
 
6.
Avdeev SN, Chuchalin AG. Severe community-acquired pneumonia. Russian Medical Journal. – 2001, 9(5): 177–178.
 
7.
Jia YX, Sekizawa K, Ohrui T, Nakayama K, Sasaki H. Dopamine D1 receptor antagonist inhibits swallowing reflex in guinea pigs. Am J Physiol. 1998; 274: R76–R80.
 
8.
Nakagawa T, Ohrui T, Sekizawa K, Sasaki H. Sputum substance P in aspiration pneumonia. Lancet 1995; 345: 1447.
 
9.
Prass K, Braun JS, Dirnagl U, Meisel C, Meisel A. Stroke propagates bacterial aspiration to pneumonia in a model of cerebral ischemia. Stroke 2006; 37: 2607–2612.
 
10.
Prass K, Meisel C, Hoflich C, et al. Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1 like immunostimulation. J Exp Med. 2003; 198: 725–736.
 
11.
Chamorro A, Meisel A, Planas AM, Urra X, van de Beek D, Veltkamp R. The immunology of acute stroke. Nat Rev Neurol. 2012; 8: 401–410.
 
12.
Marklund N, Peltonen M, Nilsson TK, Olsson T. Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke. J Intern Med. 2004; 256: 15–21.
 
13.
Tuosto L, Cundari E, Gilardini Montani MS, Piccolella E. Analysis of susceptibility of mature human T lymphocytes to dexamethasone-induced apoptosis. Eur J Immunol. 1994; 24: 1061–1065.
 
14.
Chamorro A, Urra X, Planas AM. Infection after acute ischemic stroke: a manifestation of brain-induced immunodepression. Stroke 2007; 38: 1097–1103.
 
15.
Meisel C, Schwab JM, Prass K, Meisel A, Dirnagl U. Central nervous system injury-induced immune deficiency syndrome. Nat Rev Neurosci. 2005; 6: 775–786.
 
16.
Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis. 2010; 51(Suppl 1): S81–S87.
 
17.
Bartlett JG. Community-acquired pneumonia. Int J Clin Pract Suppl. 2000, 18–22.
 
18.
Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001; 344: 665–671.
 
19.
Stott D, Falconer A, Miller H, Tilston JC, Langhorne P. Urinary tract infection after stroke. QJM 2009; 102: 243–249.
 
20.
Walter U, Knoblich R, Steinhagen V, Donat M, Benecke R, Kloth A. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. J Neurol. 2007; 254: 1323–1329.
 
21.
Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke 2003; 34: 975–981.
 
22.
Jones DJ, Munro CL, Grap MJ. Natural history of dental plaque accumulation in mechanically ventilated adults: A descriptive correlational study. Intensive Crit Care Nurs. 2011; 27: 299–304.
 
23.
Munro CL, Grap MJ, Elswick RK Jr, McKinney J, Sessler CN, Hummel RS. 3rd Oral health status and development of ventilator-associated pneumonia: A descriptive study. Am J Crit Care 2006; 15: 453–60.
 
24.
Türk G, Kocaçal Güler E, Eser I, Khorshid L. Oral care practices of intensive care nurses: A descriptive study. Int J Nurs Pract. 2012; 18: 347–53.
 
25.
Laudy AE. Systemy MDR–istotny mechanizm oporności pałeczek Gram-ujemnych na antybiotyki i chemioterapeutyki. Post Mikrobiol. 2008; 47: 415–422.
 
26.
Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet 1996; 348: 123–124.
 
27.
Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagiaafter stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36: 2756–2763.
 
28.
Rofes L, Vilardell N, Clavé P. Post-stroke dysphagia: progress at last. Neurogastroenterol Motil. 2013 Apr; 25(4): 278–82.
 
29.
Lindner-Pfleghar B, Neugebauer H, Stösser S, Kassubek J, Ludolph A, Dziewas R, Prosiegel M, Riecker A. Management of dysphagia in acute stroke: A prospective study for validation of current recommendations. Nervenarzt. 2017 Jan 10. doi: 10.1007/s00115-016-0271-1.
 
30.
Czernuszenko A. Postępowanie w dysfagii neurogennej. Otorynolaryngologia 2016; 15(2): 68–74.
 
31.
Doggett DL, Tappe KA, Mitchell MD, Chapell R, Coates V, Turkelson CM. Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Dysphagia. 2001 Fall; 16(4): 279–95.
 
32.
Ovbiagele B, Hills NK, Saver JL, Johnston SC. Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization. J Stroke Cerebrovasc Dis. 2006; 15: 209–213.
 
33.
Marik PE, Careau P. The role of anaerobes in patients with ventilatorassociated pneumonia and aspiration pneumonia: a prospective study. Chest 1999; 115: 178–183.
 
34.
Emsley HC, Hopkins SJ. Acute ischaemic stroke and infection: recent and emerging concepts. Lancet Neurol. 2008; 7: 341–353.
 
35.
Emsley HC, Smith CJ, Hopkins SJ. Infection and brain-induced immunodepression after acute ischemic stroke. Stroke 2008; 39: e7.
 
36.
Whalen MJ, Carlos TM, Clark RS, et al. The relationship between brain temperature and neutrophil accumulation after traumatic brain injury in rats. Acta Neurochir Suppl. 1997; 70: 260–261.
 
37.
Takagi K, Ginsberg MD, Globus MY, Martinez E, Busto R. Effect of hyperthermia on glutamate release in ischemic penumbra after middle cerebral artery occlusion in rats. Am JPhysiol. 1994; 267: H1770–H1776.
 
38.
Wright WL. Sodium and fluid management in acute brain injury. Curr Neurol Neurosci Rep. 2012; 12: 466–473.
 
39.
Ward K, Seymour J, Steier J, Jolley CJ, Polkey MI, Kalra L, et al. Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough. Eur Respir J. 2010; 36: 1383–1390.
 
40.
Goldstein RS. Pulmonary rehabilitation in chronic respiratory insufficiency. 3. Ventilatory muscle training. Thorax. 1993; 48: 1025–1033.
 
41.
Gagar VF, Shevchenko YuA. Physical rehabilitation of patients with focal pneumonia in conditions of permanent establishment. Pedagogics, psychology and medical and biological problems of the physical upbringing and sports 2009; 7: 37–39.
 
42.
Kwolek A. Rehabilitacja neurologiczna, Schorzenia i urazy mózgowia. [w] Rehabilitacja medyczna, Urban & Partner, Wrocław 2003.
 
43.
Westendorp WF, Vermeij J, Vermeij F, Den Hertog HM, Dippel DWJ, van de Beek D, Nederkoorn PJ. Antibiotic therapy for preventing infections in patients with acute stroke. Cochrane Database Syst Rev. 2012; 1: 008530.
 
44.
Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008. Cerebrovasc Dis. 2008; 25: 457–507.
 
eISSN:1898-7516
ISSN:1898-2395
Journals System - logo
Scroll to top