Limits...
Risk of pneumonia associated with zero-degree head positioning in acute ischemic stroke patients treated with intravenous tissue plasminogen activator.

Palazzo P, Brooks A, James D, Moore R, Alexandrov AV, Alexandrov AW - Brain Behav (2016)

Bottom Line: A total of eight patients with pneumonia were intubated and mechanically ventilated, and one patient received bilevel positive airway pressure ventilation during the 0° positioning period.Pneumonia cases had significantly longer hospitalizations (14.5 ± 12 vs. 6.6 ± 9 days; mean difference 7.97, 95% CI = 1.1-14.8; P = 0.026) and higher median discharge mRS score (4 vs. 3: P = 0.003).Rates for pneumonia may be further reduced by eliminating use of a 0° protocol in intubated/mechanically ventilated patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroscience S. Giovanni Calibita-Fatebenefratelli Hospital Rome Italy.

ABSTRACT

Introduction: In the hyperacute phase of ischemic stroke, a 0° position is recommended to increase cerebral perfusion in nonhypoxic patients able to tolerate lying flat. However, use of 0° positioning is not uniformly applied in clinical practice, most likely due to concerns of aspiration pneumonia. We aimed to determine the risk of pneumonia associated with 0° head of bed positioning in acute stroke patients treated with thrombolytic therapy.

Methods: A retrospective descriptive study was conducted using prospectively collected, consecutive acute ischemic stroke patients treated with IVtPA whose head of bed was positioned at 0° for the first 24 h. Rates of hospital-acquired pneumonia were determined using a strict adjudication process to insure accuracy of pneumonia diagnoses. Quantitative characteristics were analyzed in SPSS to compare differences between "true" pneumonia cases and nonpneumonia cases.

Results: Twenty-four of 333 (7.2%) patients had mention the diagnosis of pneumonia in the registry and/or medical record. Of these cases, only 15 (4.5%) met evidence-based diagnostic criteria for hospital-acquired pneumonia. The 15 adjudicated cases had similar median admission NIHSS scores to nonpneumonia cases (10 vs. 9, respectively; P = ns), but were older (74 ± 15 vs. 64 ± 17 years; mean difference 9.889, 95 CI = 1.2-18.6; P = 0.026). A total of eight patients with pneumonia were intubated and mechanically ventilated, and one patient received bilevel positive airway pressure ventilation during the 0° positioning period. Pneumonia cases had significantly longer hospitalizations (14.5 ± 12 vs. 6.6 ± 9 days; mean difference 7.97, 95% CI = 1.1-14.8; P = 0.026) and higher median discharge mRS score (4 vs. 3: P = 0.003).

Conclusions: Zero-degree head of bed positioning in the first 24 h following an acute ischemic stroke treated with IV-tPA was associated with acceptable rates of pneumonia. Rates for pneumonia may be further reduced by eliminating use of a 0° protocol in intubated/mechanically ventilated patients.

No MeSH data available.


Related in: MedlinePlus

Pneumonia case adjudication.
© Copyright Policy - creativeCommonsBy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4834933&req=5

brb3425-fig-0001: Pneumonia case adjudication.

Mentions: A total of 333 registry records met inclusion in the study, and of these 24 (7.2%) had mention the term pneumonia in either the medical record or registry (Fig. 1). Adjudication of alleged pneumonia cases identified misdiagnosis of pneumonia in six of the 24 patients when ATS/IDS criteria were applied (American Thoracic Society; Infectious Diseases Society of America, 2005). An additional three patients were removed due to the presence of pneumonia on admission, or documentation of an antecedent event such as vomitus with aspiration occurring in the prehospital environment prior to hospital arrival. Of the remaining 15 (4.5%) cases in the series, 1 (0.3%) case had a clear causal association with 0° positioning represented by vomitus with documentation of aspiration, decreasing pulse oximetry values, and respiratory sound changes during the 24 h 0° HOB positioning period, whereas the other 14 (4.2%) cases could not be ruled out as being associated with 0° positioning in the first 24 h after extensive revision by our team of interdisciplinary experts (Table 1).


Risk of pneumonia associated with zero-degree head positioning in acute ischemic stroke patients treated with intravenous tissue plasminogen activator.

Palazzo P, Brooks A, James D, Moore R, Alexandrov AV, Alexandrov AW - Brain Behav (2016)

Pneumonia case adjudication.
© Copyright Policy - creativeCommonsBy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834933&req=5

brb3425-fig-0001: Pneumonia case adjudication.
Mentions: A total of 333 registry records met inclusion in the study, and of these 24 (7.2%) had mention the term pneumonia in either the medical record or registry (Fig. 1). Adjudication of alleged pneumonia cases identified misdiagnosis of pneumonia in six of the 24 patients when ATS/IDS criteria were applied (American Thoracic Society; Infectious Diseases Society of America, 2005). An additional three patients were removed due to the presence of pneumonia on admission, or documentation of an antecedent event such as vomitus with aspiration occurring in the prehospital environment prior to hospital arrival. Of the remaining 15 (4.5%) cases in the series, 1 (0.3%) case had a clear causal association with 0° positioning represented by vomitus with documentation of aspiration, decreasing pulse oximetry values, and respiratory sound changes during the 24 h 0° HOB positioning period, whereas the other 14 (4.2%) cases could not be ruled out as being associated with 0° positioning in the first 24 h after extensive revision by our team of interdisciplinary experts (Table 1).

Bottom Line: A total of eight patients with pneumonia were intubated and mechanically ventilated, and one patient received bilevel positive airway pressure ventilation during the 0° positioning period.Pneumonia cases had significantly longer hospitalizations (14.5 ± 12 vs. 6.6 ± 9 days; mean difference 7.97, 95% CI = 1.1-14.8; P = 0.026) and higher median discharge mRS score (4 vs. 3: P = 0.003).Rates for pneumonia may be further reduced by eliminating use of a 0° protocol in intubated/mechanically ventilated patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroscience S. Giovanni Calibita-Fatebenefratelli Hospital Rome Italy.

ABSTRACT

Introduction: In the hyperacute phase of ischemic stroke, a 0° position is recommended to increase cerebral perfusion in nonhypoxic patients able to tolerate lying flat. However, use of 0° positioning is not uniformly applied in clinical practice, most likely due to concerns of aspiration pneumonia. We aimed to determine the risk of pneumonia associated with 0° head of bed positioning in acute stroke patients treated with thrombolytic therapy.

Methods: A retrospective descriptive study was conducted using prospectively collected, consecutive acute ischemic stroke patients treated with IVtPA whose head of bed was positioned at 0° for the first 24 h. Rates of hospital-acquired pneumonia were determined using a strict adjudication process to insure accuracy of pneumonia diagnoses. Quantitative characteristics were analyzed in SPSS to compare differences between "true" pneumonia cases and nonpneumonia cases.

Results: Twenty-four of 333 (7.2%) patients had mention the diagnosis of pneumonia in the registry and/or medical record. Of these cases, only 15 (4.5%) met evidence-based diagnostic criteria for hospital-acquired pneumonia. The 15 adjudicated cases had similar median admission NIHSS scores to nonpneumonia cases (10 vs. 9, respectively; P = ns), but were older (74 ± 15 vs. 64 ± 17 years; mean difference 9.889, 95 CI = 1.2-18.6; P = 0.026). A total of eight patients with pneumonia were intubated and mechanically ventilated, and one patient received bilevel positive airway pressure ventilation during the 0° positioning period. Pneumonia cases had significantly longer hospitalizations (14.5 ± 12 vs. 6.6 ± 9 days; mean difference 7.97, 95% CI = 1.1-14.8; P = 0.026) and higher median discharge mRS score (4 vs. 3: P = 0.003).

Conclusions: Zero-degree head of bed positioning in the first 24 h following an acute ischemic stroke treated with IV-tPA was associated with acceptable rates of pneumonia. Rates for pneumonia may be further reduced by eliminating use of a 0° protocol in intubated/mechanically ventilated patients.

No MeSH data available.


Related in: MedlinePlus