Etiopathogenesis, diagnosis and treatment strategies for stroke-associated pneumonia

Abstract

Objective: The stroke-associated pneumonia (SAP) is considered an important risk factor for death following a stroke. It is important for clinicians to be able to recognize the causes of its occurrence, characteristic clinical and radiological signs and to be aware of treatment and prophylaxis in the early post-stroke period. This review article is devoted to the analysis and presentation of modern data on etiopathogenesis, modern strategies for early diagnosis and management of patients with stroke-associated pneumonia in the early post-stroke period. Design: Review of observational studies. Methods: We used following databases: PubMed, Web of Science, Scopus for the period of time 2019-2023 for studies search. Data from selected studies were extracted, including study design, data source, outcome definition, sample size, etiopathogenesis, diagnostic criteria and treatment strategies for stroke-associated pneumonia. Results: Totally 354 studies were reviewed, and after the selection process, 37 studies were included in this article. The incidence of stroke-associated pneumonia in patients with acute stroke ranged from 6.7 % to 37.98 %. Despite the abovementioned practical statements, there is currently no «gold standard» or generally accepted criteria for the diagnosis and treatment of SAP. As a rationale, detection of patients with the highest risk of SAP facilitates both prevention and treatment. The highest risks are associated with the age over 65, brain stem infarction with dysphagia, decreased throat and cough reflexes, impaired consciousness. Conclusion: The identification of high-risk patients requires knowledge of the modern criteria for diagnosing SAP. Since most SAP consists of aspiration pneumonia, hospital-acquired pneumonia, healthcare-associated pneumonia, pneumonia caused by artificial ventilation, partial diagnosis, treatment, rehabilitation, are related to the provision of medical care.

Keywords

• acute stroke
• stroke-associated pneumonia
• etiopathogenesis
• diagnostic criteria
• risk factors
• treatment strategies