[Dysphagia] CVA Research

[wwasmith at comcast.net (wwasmith@comcast.net)]

Hi Chris,

Here's a couple I pulled out:

Gordon, C, Langton-Hewer R, Wade DT.  Dysphagia in acute stroke.  British Medical Journal, 1987;295;411-414.  Showed that 19% of CVA patients with dysphagia developed pneumonia compared with 8% of CVA patients without dysphagia, altho the difference did not reach statistical significance.  

There are lots of studies that correlate stroke with aspiration (which of course is one way to reach pneumonia) Ding R, Logemann JA,  Pneumonia in Stroke Patients:  A retrospective study.  Dysphagia, 2000; 15; 51-57, between 48 and 55% of the 277 consectively studied patients aspirated.  Pneumonia was correlated with a higher incidence of HTN, diabetes.  

Try this also:  Schmidt J., Holas M., halvorson, K, Reding M.  (1994).  Dysphagia, 9, 7-11.  Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke.  I just reviewed the abstract which didn't give any details.

Is the patient being anticoagulated with some drug other than aspiran (via a nonoral route)?  Heparin?  Coumadin?  Then probably the low dose aspiran is not needed, and skipping a day or so (until you get there, which he/she clearly thinks will be soon!) has not been deemed harmful by the neurologist for the recurrance of a subsequent stroke.  Swallowing water (with a baby aspiran) will wash all the flora in the mouth into the lungs if the patient is aspirating, and without adequate oral hygiene, that's a setup for a pneumonia.  Are there other diagnoses that the MD is factoring into his/her decision?

If the patient is newly admitted and swelling in the brain hasn't maxed yet (at 72 hours, if I recall correctly) the patient may get slightly worse before recovery commences.

Wendy

--
Wendy Avery-Smith, MS, OTR/L
8A Florence St.
Andover MA 01810
(978) 475-3545

WWASmith@comcast.net


> Good Morning,
> During a discussion with one of our neurologist he said "The leading
> cause of death once a patient gets to the hospital after an acute CVA is
> aspiration pneumonia" and that "Early administration of PO aspirin in
> acute CVA does not have any effect on long-term outcomes, so they can be
> STRICT npo until speech sees them!!!!!!!!"
> 
> I have searched and asked the neurologist for sources.  Does anyone
> have any references that may prove or disprove these statements?
> 
> Thank you in advance,
> Chris Babashka
> 
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