Pneumonia In Acute Stroke Patients Research Articles

The impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients: A randomized controlled trial.

Dysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients. A single-blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40min/session, 1 session/day, and 5days/week for 4weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4weeks of intervention for both groups. Before treatment, all patients were susceptible to pneumonia after two and 4weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p<0.05) and a statistically significant increase in incidence of SAP after 2weeks of intervention only in the control group (p<0.05). The results also showed a significant negative correlation between GUSS score and SAP (r=- 0.3662, p=0.0018) IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.

Expression of Concern: Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements.

Expression of Concern: Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements.

The Preventive Effect of Dysphagia Screening on Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis.

(1) Background: Dysphagia is common in acute stroke patients and is a major risk factor for aspiration pneumonia. We investigated whether the early detection of dysphagia in stroke patients through screening could prevent the development of pneumonia and reduce mortality; (2) Methods: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published up to November 2021. We included studies that performed dysphagia screening in acute stroke patients and evaluated whether it could prevent pneumonia and reduce mortality rates. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions tool, and publication bias was evaluated by the funnel plot and Egger’s test; (3) Results: Of the 6593 identified studies, six studies met the inclusion criteria for analysis. The screening group had a significantly lower incidence of pneumonia than the nonscreening group did (odds ratio (OR), 0.60; 95% confidence interval (CI), 0.42 to 0.84; p = 0.003; I2, 66%). There was no significant difference in mortality rate between the two groups (OR, 0.61; 95% CI, 0.33 to 1.13; p = 0.11; I2, 93%); (4) Conclusions: Early screening for dysphagia in acute stroke patients can prevent the development of pneumonia.

Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung

Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital Bandung Abstract Background and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung. Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria. Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia. Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

A Preliminary Investigation of Relationships among Pharyngeal Acidity, Dysphagia, and Pneumonia in Acute Stroke

Individuals with acute stroke on nonoral feeding regimens frequently develop pneumonia, questioning the long-held belief that pneumonia in stroke patients is a caused by food and liquid aspiration alone. Refluxate and colonized oral secretions are thought to contribute to an acidic oropharyngeal environment. If aspirated, these colonized oral secretions with increased acidity, can result in increased risk to the respiratory system. This study aimed to investigate the relationship between pharyngeal acidity, dysphagia, and pneumonia in acute stroke patients. Twenty-one patients (mean age 67 years) admitted to a stroke unit were recruited into this study. We evaluated their stroke and dysphagia severity via clinical measures. Pharyngeal acidity was measured using a Restech Dx-pH measurement probe placed transnasally for 24 hours. Sixty two (62%) patients presented with moderate to severe stroke and 38% with dysphagia. Seven patients (33%) were positive for pharyngeal acidity. Two patients with pharyngeal acidity were diagnosed with chest infection. Pharyngeal acidity was significantly correlated with stroke severity (r = 0.487, P = 0.03) and significantly and inversely correlated to clinical swallow performance (rho = -0.626, p = 0.02). Additionally, pharyngeal acidity was significantly associated with categorical dysphagia scores (c2(3,21) = 10.5, p&lt;0.01), functional oral intake (c2(3,21) = 15.7, p&lt;0.001), presence of modified diets (χ2(1,21) = 14.0, p=0.0001), and tube feeding (χ2 (1,21) = 9.992, p = 0.002). Preliminary results suggest that acute stroke patients with dysphagia may present with increased risk for increased pharyngeal acidity. Pharyngeal acidity can result in negative sequelea, including respiratory complications. A better understanding of these potential relationships may lead to enhanced assessment and treatment approaches that limit pharyngeal acidity and resulting respiratory complications in acute stroke patients.

Acid-suppressive medications and risk of pneumonia in acute stroke patients: A systematic review and meta-analysis

GoalWe performed a systematic review and meta-analysis aiming to clarify the relationship between acid-suppressive medication (ASM) and the risk of pneumonia in acute stroke. MethodsThe included studies examined patients with an acute ischemic and/or hemorrhagic stroke, assessed the relationship of one or both groups of ASM, histamine-2 receptor antagonist (H2RA) and proton-pump inhibitor (PPI), as a variable of interest, and used the occurrence of hospital-acquired pneumonia (HAP) as an outcome measure. The search was conducted in MEDLINE, Cochrane, Embase, and Google Scholar. Random-effects meta-analyses were used to obtain pooled estimates of the effect. Results5 retrospective cohort-studies fulfilled study criteria. The results revealed a higher risk of pneumonia for both, patients receiving PPI (adjusted relative risk [RR] 2.37, 95% confidence interval [CI] 1.36–4.17, I2 0%) and H2RAs (adjusted RR 1.73, 95% CI 0.74–4.25, I2 68.3%), although the latter did not reach statistical significance. A comparison of the overall acid versus non-acid groups using unadjusted values yielded likewise an increased risk for pneumonia for patients receiving ASM (unadjusted RR 4.65, 95% CI 1.64–13.16, I2 93.3%). ConclusionResults of this meta-analysis show an increased risk for HAP in acute stroke patients who receive ASM, particularly those exposed to PPIs. Larger, well-controlled studies in acute stroke populations are needed to establish a clearer association between ASM and HAP. These results, however, urge caution when prescribing ASM – especially to stroke patients considered to be at high risk for pneumonia.

The use of an emergency department dysphagia screen is associated with decreased pneumonia in acute strokes

BackgroundDysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute stroke patients. MethodsWe conducted a pre-post trial evaluating rates of pneumonia in patients with ischemic and hemorrhagic stroke both before and after the use of our ED dysphagia screen. We defined HAP as a new infiltrate treated with antibiotics. Rates of HAP were compared using the χ2 test. Any patients transferred out of our health system were excluded. ResultsWe evaluated 419 and 469 preintervention hemorrhagic strokes and 1022 and 462 post screen ischemic strokes respectively. In the hemorrhagic groups rates of dysphagia were similar but rates of HAP decreased from 19% to 15% (P < 0.001) in the pre- post groups respectively. In the ischemic stroke groups rates of HAP decreased from 13.8% to 8% in the pre-post groups respectively, (P = 0.007). Rates of intubation were similar in the hemorrhagic groups and were higher in the post screen ischemic stroke cohort. ConclusionThe use of our ED dysphagia screen was associated with a significant reduction in the rates of HAP in both ischemic and hemorrhagic stroke patients. Given the high rates of dysphagia and significant comorbidity and complications for these stroke patients, the use of a screen is warranted.

Development and internal validation of a prediction rule for post-stroke infection and post-stroke pneumonia in acute stroke patients.

IntroductionPatients with acute stroke are at high risk for infection. These infections are associated with unfavourable outcome after stroke. A prediction rule can identify the patients at the highest risk for strategies to prevent infection. We aim to develop a prediction rule for post-stroke pneumonia and other infections in patients with acute stroke.Patients and methodsWe used data from the Preventive Antibiotics in Stroke Study, a multicentre randomised trial comparing preventive ceftriaxone vs. standard stroke care in patients with acute stroke. Possible predictors for post-stroke pneumonia or infection were selected from the literature. Backward elimination logistic regression analysis was used to construct prediction rules for pneumonia or infection. Internal validation was performed and a risk chart was constructed. We adjusted for preventive antibiotic use.ResultsPneumonia was diagnosed in 159 of the 2538 included patients, and infection in 348. Pneumonia was predicted by higher age, male sex, pre-stroke disability, medical history of chronic obstructive pulmonary disease, more severe stroke, dysphagia and intracerebral haemorrhage (rather than ischaemic stroke). Infections were predicted by higher age, male sex, history of diabetes, chronic obstructive pulmonary disease, more severe stroke, dysphagia, use of bladder catheter, preventive antibiotic use and intracerebral haemorrhage. With the prediction rule developed, risks for pneumonia ranged from 0.4% to 56.2% and from 1.8% to 88.0% for infection. Discrimination of the score was good (C-statistic, 0.84; 95% CI: 0.81–0.87 and 0.82; 95% CI: 0.79–0.84 for pneumonia and infection).ConclusionsThe Preventive Antibiotics in Stroke Study pneumonia and infection rule identify patients at the highest risk for post-stroke pneumonia or infection and may be used for future studies and novel therapies, after confirmation in an external population.

The relationship between pneumonia and Glasgow coma scale assessment on acute stroke patients

Pneumonia is one of the most frequent medical complications of a stroke. Despite the well-documented association of a stroke associated infections with increased mortality and worse long-term outcome, on the other hand, the limited data available on independent predictors of pneumonia in acute stroke patients in an emergency unit. To determine the independentrelationship between pneumonia and Glasgow Coma Scale assessment on acute stroke patients. The cohort retrospective study observed 55 acute stroke patients who stayed in intensive care unit Adam Malik General Hospital from January until August 2017. Pneumonia was more frequent in patients with Ischemic stroke (OR 5.40; 95% CI: 1.28 – 6.40, p=0.003), higher National Institute of Health Stroke Scale (NIHSS) (p=0.014) and lower Glasgow Coma Scale (p=0.0001). Analysis multivariate logistic regression identified NIHSS as an independent of predictors of pneumonia (95% CI : 1.047 – 1.326, p=0.001). Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficits evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

Predicting Pneumonia in Acute Stroke Patients Using the Glasgow Coma Scale Score

Predicting Pneumonia in Acute Stroke Patients Using the Glasgow Coma Scale Score

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Background: Knowledge on the risk factors of developing pneumonia, one of the top causes of mortality in acute stroke patients admitted to a tertiary government hospital, is lacking. Aim and Objective: This study aimed to determine the factors associated with the risk of developing pneumonia in acute stroke patients admitted to the emergency department of a tertiary government hospital. Materials and Methods: A retrospective matched case–control study involving acute stroke patients admitted to the emergency department of a tertiary government hospital with 168 pneumonia patients matched with 168 controls by sex was employed. Age, sex, vascular risk factors, previous hospitalization within the past 3 months, type and location of stroke, need for intubation, length of hospital emergency room stay, National Institute of Health Stroke Scale (NIHSS) score on admission, pre-morbid Modified Rankin Scale (mRS) score, and outcome (mortality, NIHSS score and mRS score at discharge) were obtained from the medical charts. Odds ratios were calculated using a multivariate logistic regression analysis. Among stroke patients developing pneumonia, the type of pneumonia and microorganisms were identified. Results: Smoking, alcohol intake, dysphagia, hemorrhagic stroke, need for intubation, and age were associated with pneumonia. Pneumonia increases the odds of mortality and disability by 14 and 7 times, respectively. Hospital-acquired pneumonia is the most common type with Acinetobacter baumanii and Klebsiella pneumonia as the most common microorganisms identified. Conclusion: Age, alcohol intake, dysphagia, hemorrhagic stroke, and need for intubation increase the risk for post-stroke pneumonia with organisms isolated consistent with nosocomial pneumonia.

Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements.

Swallowing dysfunction caused by stroke is a risk factor for aspiration pneumonia. Tongue pressure measurement is a simple and noninvasive method for evaluating swallowing dysfunction. We have hypothesized that low tongue pressure may be able to predict pneumonia occurrence in acute stroke patients. Tongue pressure was measured using balloon-type equipment in 220 acute stroke patients. The modified Mann Assessment of Swallowing Ability (MASA) score was evaluated independently on the same day. Tongue pressure was measured every week thereafter. An improvement in tongue pressure was observed within the first 2 weeks. Receiver operating curve analysis was performed to determine the ability of tongue pressure to predict modified MASA score <95, which suggests swallowing dysfunction. The optimal cutoff for tongue pressure was 21.6 kPa (χ2 = 45.82, p<0.001, sensitivity 95.9%, specificity 91.8%, area under the curve = 0.97). The tongue pressure was significantly lower in patients with pneumonia than in those without pneumonia. Using a Cox proportional hazard model for pneumonia onset with a cutoff tongue pressure value of 21.6 kPa and adjustment for age, sex, and National Institutes of Health Stroke Scale score at admission, the tongue pressure had additional predictive power for pneumonia onset (hazard ratio, 7.95; 95% confidence interval, 2.09 to 52.11; p = 0.0013). In the group with low tongue pressure, 27 of 95 patients showed improvement of tongue pressure within 2 weeks. Pneumonia occurred frequently in patients without improvement of tongue pressure, but not in patients with improvement (31/68 and 2/27, p<0.001). Tongue pressure is a sensitive indicator for predicting pneumonia occurrence in acute stroke patients.

Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists and Risk of Pneumonia in Patients with Acute Stroke

Pneumonia is a serious complication of stroke. Several studies have indicated that certain gastric acid suppressants may be associated with an increased risk of pneumonia in hospitalized patients. However, the association between type of acid suppressant and pneumonia in acute stroke patients remains controversial. The purpose of this study was to clarify the association between the type of acid suppressant and the occurrence of pneumonia in acute stroke patients. This retrospective observational study used data from the national Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted to acute-care hospitals with stroke. The outcome was the occurrence of pneumonia assessed using diagnostic codes. We performed propensity score-matched analysis to compare the outcome between proton pump inhibitor (PPI) users and histamine-2 receptor antagonist (H2RA) users. A total of 77,890 stroke patients were identified, of whom 63,980 were prescribed H2RAs and 13,910 were prescribed PPIs. Overall, 1490 (10.7%) of the patients receiving PPIs and 6401 (10.0%) of the patients receiving H2RAs developed pneumonia after stroke. After propensity score matching, the incidence of pneumonia in PPI users was not different from that in H2RA users (odds ratio: 1.10, 95% confidence interval: .99-1.21). No significant difference in the incidence of pneumonia was seen between users of PPIs and H2RAs after acute stroke.

Predictors of pneumonia in acute stroke in patients in an emergency unit.

To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. 159 patients (18-90 years) were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001), higher National Institute of Health Stroke Scale (NIHSS) (p = 0.047) and, lower Glasgow Coma Score (GCS) (p < 0.0001). Patients with pneumonia had longer hospitalization (p < 0.0001). Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002). Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

Abstract WP325: The Appropriate Body Position During Nasal-gastric Tube Feeding To Prevent The Aspiration Pneumonia In Acute Stroke Patients

Purpose: In acute stroke patients when initiating Nasal-gastric tube feeding (NGF) have a high risk for aspiration pneumonia, which may be related to the body position. We investigated the relationship between body position during NGF and aspiration pneumonia. Method: We enrolled consecutive acute stroke patients, 1) who were admitted from June 2011 to May 2012, 2) with a diagnosis of acute stroke within five days, and 3) who initiated NGF within two days from admission due to altered mental state or severe dysphagia. We allocated these enrolled patients into two Group alternately according to the body position during NGF; patients in the complete lateral position (Group L [n=27]) with keeping nonparalyzed side below and head up at 30-60 degrees during NGF, and patients in the spine position (Group S [n=26]) with head up at 30-60 degrees. We evaluated patients’ baseline characteristics including neurological status and vital signs, inflammatory response parameters, and the number of patients with aspiration pneumonia. Aspiration pneumonia fit three criteria: 1) at least one event of aspiration during NGF, 2) infiltrative shadows on the plain chest radiograph, and 3) no evidence of community acquired pneumonia. Results: We finally evaluated 47 patients (median age was 85 years old, 43% female). There were 32 patients with cerebral infarction and 15 with intracranial hemorrhage, median NIHSS score on admission was 17.5, and on the seventh day was 18 respectively. We analyzed 24 patients in Group L, and 23 in Group S. There was no difference in patients’ baseline characteristics, and inflammatory reaction parameters between the groups statistically significantly. However, the number of patients with aspiration pneumonia after admission was lower in Group L compared to Group S statistically significantly ( nine cases in Group L, 9 cases in Group S, P=0.034). Conclusion: The complete lateral position during the NGF has the potential to prevent aspiration pneumonia for acute stroke patients

Cough reflex testing in Dysphagia following stroke: a randomized controlled trial.

BackgroundSignificant health issues and service delivery costs are associated with post-stroke pneumonia related to dysphagia. Silent aspiration is known to increase pneumonia and mortality in this population. The utility of cough reflex testing (CRT) for reducing pneumonia in acute stroke patients was the subject of this randomised, controlled trial.MethodsPatients referred for swallowing evaluation (N = 311) were assigned to either 1) a control group receiving standard evaluation or 2) an experimental group receiving standard evaluation with CRT. Participants in the experimental group were administered nebulised citric acid with test results contributing to clinical decisions. Outcomes for both groups were measured by pneumonia rates at 3 months post evaluation and other clinical indices of swallowing management.ResultsAnalysis of the data identified no significant differences between groups in pneumonia rate (P = 0.38) or mortality (P = 0.15). Results of CRT were shown to influence diet recommendations (P < 0.0001) and referrals for instrumental assessment (P < 0.0001).ConclusionsDespite differences in clinical management between groups, the end goal of reducing pneumonia in post stroke dysphagia was not achieved.

Abstract 3651: Reducing Incidence of Hospital Acquired Pneumonia After Acute Stroke Through Implementation Of Simple Bedside Swallow Assessment

The incidence of hospital-acquired pneumonia (HAP) has been estimated to occur in acute stroke patients with rates reported as high as approximately 10 - 25%. Mechanical ventilation, multiple infarct locations, dysphagia and abnormal chest x-ray findings all contribute to increased risk for dysphagia and ultimately development of pneumonia. Because fatality rates of 20 - 45% have been reported in HAP, stroke care nurses are urged to comply with guidelines recommending implementation of simple bedside swallow assessments to identify high risk patients and institute appropriate nursing interventions to avoid development of the potentially fatal complication of stroke related pneumonia. A retrospective review of 493 patients admitted to the stroke service of a community hospital was performed to determine incidence of hospital acquired pneumonia in acute stroke patients. The sample of patients were admitted through the emergency department and depending on the severity of stroke, were admitted to either an ICU or step-down unit bed. The simple bedside swallow screen was completed by an emergency department nurse. The patient was not allowed anything by mouth until the assessment was completed. If the assessment revealed the patient had a competent level of cognition, ability to adequately handle secretion in a sitting position, and maintain a venous pulse oxygenation of greater than 94%, the patient was asked to swallow three sequential one ounce medicine cups of water. If coughing, choking, drooling, or oxygen desaturation was assessed, the patient was maintained nothing by mouth until a formal swallow evaluation was completed by a speech therapist. During the period of 1/1/09 - 7/30/11, this hospital’s annual incidence of HAP in the post stroke patient was found to be significantly less than nationally published incidence. The diagnosis of HAP was based upon Center for Disease Control Guidelines for Hospital-Acquired Pneumonia. The patients reported as developing HAP met the criteria of having a primary discharge of stroke and a secondary discharge diagnosis of hospital acquired pneumonia. This community hospital’s mean incidence of hospital acquired pneumonia over the total 31 month study period was 3.6%. A simple bedside swallow screen performed by competent emergency department nurses to detect swallowing difficulty quickly and accurately in stroke patients prior to administering anything by mouth, has achieved the goal of identifying patients at high risk for dysphagia and avoiding the potential complication of hospital acquired pneumonia.

Abstract 2666: Oral Care Protocol Reduces Risk of Aspiration Pneumonia in Acute Stroke Patients

Background: Swallowing is a complex process. Dysphagia, or impaired swallowing, may result in aspiration and can significantly contribute to morbidity and mortality. Approximately 25-70% of patients with stroke have dysphagia. Dysphagia and dependency for feeding/oral care are important risk factors in the development of aspiration pneumonia, which can delay patient functional recovery. Hospital acquired pneumonia (HAP) prevention studies have focused on critical care environments with intubated patients. Far fewer studies have investigated non-intubated patients, however the same physiologic principles apply. Purpose: The purpose of this program is to present an evidence-based practice initiative implemented utilizing ventilator-associated pneumonia (VAP) oral care techniques in the non-intubated, at risk stroke population. Methods: A multidisciplinary educational approach was utilized to implement a comprehensive oral care program recommended by the Centers for Disease Control and Prevention (CDC). Care practices include all patients, regardless of mental status, have their teeth brushed at least twice daily. Additionally, patients at risk who are eating, have their teeth brushed prior to meals and then mouth cleansed and moisturized after meals. Patients with altered mental status who are NPO receive oral care every 2-4 hours using swabs/cleanser and moisturizer. Results: Aspiration pneumonia rate of stroke patients on the neuro/stroke unit was tracked. Pre-implementation aspiration pneumonia rates were 4% (128 patients). Post implementation aspiration pneumonia rates were reduced to 1.4% (268 patients). Conclusion: Prevention of hospital acquired pneumonia is essential and has been shown to improve outcomes. A team approach is vital in providing oral care and preventing potential aspiration pneumonia. A nursing-led research study will be undertaken to further explore this topic.

Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit

Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit

Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit

Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit