Predictors and consequences of pneumonia in critically ill patients with stroke

Ascertain the incidence, predictors and consequences of early (within 48 hours of admission) and nosocomial pneumonia among critically ill patients with stroke.

Medical records of critically ill patients with acute stroke were reviewed. Predictors and consequences of pneumonia were determined with analysis of variance.

55 patients, aged 33 to 91 (median 74) years, were admitted. The stroke was located at the brainstem in 14 (26.4%) patients. Nine patients (16.4%) had early pneumonia and additional 17 patients (30.9%) developed nosocomial pneumonia. Patients with brain-stem stroke were more likely to develop early pneumonia (p =.04). Nosocomial pneumonia incidence was higher in patients who failed swallowing evaluation (RR = 6.3, 95% CI: 0.9-43.0) and in those who were intubated (58.6% v 0%, p =.00008). Also, nosocomial pneumonia was associated with longer duration of mechanical ventilation and prolonged hospital stay. Nineteen patients (34.5%) died at the hospital. They were more likely to be older (median 77 versus 69 years, p =.03) with higher admission acuity of illness.

Pneumonia complicated stroke in 47% of critically ill patients and adversely impacted the duration of mechanical ventilation and overall length of hospital stay. Aggressive preventive measures are needed to reduce pneumonia occurrence in stroke patients.