Objective: Ascertain the incidence, predictors and consequences of early (within 48 hours of admission) and nosocomial pneumonia among critically ill patients with stroke.
Methods: Medical records of critically ill patients with acute stroke were reviewed. Predictors and consequences of pneumonia were determined with analysis of variance.
Results: 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.
Conclusion: 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.