Abstract 4002: Vulnerability to Contralateral Pneumonia in Patients with Hemispheric Strokes
Background: Stroke is associated with contralateral focal motor, visual, and sensory deficits. It remains unclear whether there is laterality to muscle deficits involved in upper airway and respiration. We hypothesized that there is laterality in motor deficits and coordination of muscles involved in upper airway and respiration in acute stroke resulting in greater vulnerability to contralateral pneumonia in supratentorial stroke patients.
Methods: We reviewed medical records, chest radiographs, and laboratory testing to identify patients with pneumonia among a study population of 1033 adults (239 with intracerebral hemorrhage (ICH), and 794 with ischemic stroke) admitted to two University affiliated hospitals from 2008-2010. Hospital-acquired pneumonia was defined by new or progressive radiographic infiltrate and at least two clinical features (fever, leukocytosis, or purulent tracheal secretions) based on definitions used in previous studies.
Results: Overall, 76 patients (7.36%) were diagnosed with pneumonia during their hospitalization; 24 patients with bilateral pneumonia at the time of diagnosis were excluded. In all stroke patients with a unilateral stroke, a higher number of unilateral pneumonias were found in the contralateral lung (40) as compared to the ipsilateral lung (12) (OR 3.33, 95% confidence interval [CI] 1.43-7.75) after correction for endotrachial and nasogastric tube placement. The relationship was more prominent in patients with ischemic stroke patients (OR 5.20, 95% CI 1.57-17.18) as compared with patients with ICH ( OR 2.00, 95% 0.57-7.06).
Conclusions: Unilateral vulnerability to pneumonia in patients with hemispheric stroke supports targeted chest percussions and postural drainage therapies to reduce the rate of such events and associated morbidity.
- © 2012 by American Heart Association, Inc.