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DOI: 10.1055/s-2002-33033
Respiratory Complications of Stroke
Publikationsverlauf
Publikationsdatum:
02. August 2002 (online)
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ABSTRACT
Stroke is the third leading cause of death in the United States. Stroke survivors often experience medical complications and long-term disability. Disturbances in respiratory system function and complications affecting the respiratory system are common after stroke. The nature of these disorders depends on the severity and site of neurological injury. Alterations in breathing control, respiratory mechanics, and breathing pattern are common and may lead to gas exchange abnormalities or the need for mechanical ventilation. Stroke can lead to sleep disordered breathing such as central or obstructive sleep apnea. Sleep disordered breathing may also play a role in the pathogenesis of cerebral infarction. Venous thromboembolism, swallowing abnormalities, aspiration, and pneumonia are among the most common respiratory complications of stroke. Neurogenic pulmonary edema occurs less often. Close observation of the stroke patient for these potential disturbances, and implementation of prophylactic measures can prevent significant morbidity and mortality.
KEYWORDS
Apnea - venous thromboembolism - dysphagia - aspiration - neurogenic pulmonary edema
REFERENCES
- 1 Johnston K C, Li J Y, Lyden P D. Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. Stroke . 1998; 29 447-453
- 2 Stewart D G. Stroke rehabilitation, I: Epidemiologic aspects and acute management. Arch Phys Med Rehabil . 1999; 80 S4-S7
- 3 McGuire J R, Harvey R L. The prevention and management of complications after stroke. Phys Med Rehabil Clin N Am . 1999; 10 857-874
- 4 National Stroke Association. Cost of stroke. Stroke Clin Updates . 1994; 5 9-12
- 5 Wijdicks E FM, Borel C O. Respiratory management in acute neurologic illness. Neurology . 1998; 50 11-20
- 6 Becker K. Intensive care unit management of the stroke patient. Neurol Clin. 2000; 19(2)10(4) 439-454-857-874
- 6a Von Euler C. Brainstem mechanisms for generation and control of breathing pattern. In: Fishman AP ed., Handbook of Physiology Sec III. Vol. 11. 2nd ed. Bethesda, MD: American Physiologic Society 1986: 1-68.
- 7 Frank J I. Abnormal breathing patterns. In: Hacke W, ed. Neurocritical Care Heidelberg, Berlin, New York: Springer-Verlag 1994: 366-373
- 8 Howard R S, Williams A J. Chronic respiratory failure of neurogenic origin. In: Miller DH, Raps EC, eds. Critical Care Neurology Boston, Mass: Butterworth- Heinemann 1999: 249-277
- 9 Bassetti C, Aldrich M S, Quint D. Sleep-disordered breathing in patients with acute supra- and infratentorial strokes: a prospective study of 39 patients. Stroke . 1997; 28 1765-1772
- 10 Lee M C, Klassen A C, Resch J A. Respiratory pattern disturbances in ischemic cerebral vascular disease. Stroke . 1974; 5 612-616
- 10a North J B, Jennett S. Abnormal breathing patterns associated with acute brain damage. Arch Neurol . 1974; 31 338-344
- 11 Fluck D C. Chest movements in hemiplegia. Clin Sci . 1966; 31 383-388
- 12 Sandin K J. Medical complications of stroke. In: Sandin KJ, Mason KD, eds. Manual of Stroke Rehabilitation Boston, Mass: Butterworth-Heinemann 1996: 23-36
- 13 Houston J G, Morris A D, Grosset D G, Lees K R, Mc Millan N. Bone, I: Ultrasonic evaluation of movement of the diaphragm after acute cerebral infarction. J Neurol Neurosurg Psychiatry . 1995; 58 738-741
- 14 Chalela J A, Kasner S E. Cardiac and respiratory complications of stroke. Up To Date 2001. Available at: http://www.uptodate.com. Accessed September 2001
- 15 Vingerhoets F, Bogousslavsky J. Respiratory dysfunction in stroke. Clin Chest Med . 1994; 15 729-737
- 15a Nachtmann A, Selder M, Rose G, Sitzer M, Steinmetz H. Cheyne-Stokes respiration in ischemic stroke. Neurology . 1995; 45 820-821
- 16 Plum F. Mechanisms of ``central'' hyperventilation. Ann Neurol . 1982; 11 636-637
- 17 Rodriquez M, Baele P L, Marsh H M, Okazaki H. Central neurogenic hyperventilation in an awake patient with brainstem astrocytoma. Ann Neurol . 1982; 11 625-628
- 18 Bogousslavsky J, Khurana R, Deruaz J P. Respiratory failure and unilateral caudal brainstem infarction. Ann Neurol . 1990; 28 668-673
- 19 Severinghaus J W, Mitchell R A. Ondine's curse: failure of respiratory center automaticity while awake [abstract]. Clin Res . 1962; 10 122
- 20 Devereaux M W, Keane J R, Davis R L. Automatic respiratory failure associated with infarction of the medulla. Arch Neurol . 1973; 29 4652
- 21 Mohsenin V, Valor R. Sleep apnea in patients with hemispheric stroke. Arch Phys Med Rehabil . 1995; 76 71-76
- 22 Askenasy J JM, Goldhammer I. Sleep apnea as a feature of bulbar stroke. Stroke . 1988; 19 637-639
- 23 Bassetti C L, Aldrich M S. Sleep electroencephalogram changes in acute hemispheric stroke. Sleep Med . 2001; 2 185-194
- 24 Dyken M E, Somers V K, Yamada T, Ren Z Y, Zimmerman M B. Investigating the relationship between stroke and obstructive sleep apnea. Stroke . 1996; 27 401-407
- 25 Wessendorf T E, Teschler H, Wang Y-M, Konietzko N, Thilmann A F. Sleep-disordered breathing with first-ever stroke. J Neurol . 2000; 247 41-47
- 26 Bassetti C, Aldrich M S. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep . 1999; 22 217-223
- 26a Good D C, Henkle J Q, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke. Stroke . 1996; 27 252-254
- 27 Sandberg O, Frankllin K A, Bocht G, Eriksson S, Gustafson V. Nasal continuous positive airway pressure in stroke patients with sleep apnea: a randomized treatment study. Eur Respir J . 2001; 18 630-634
- 27a Sakai F, Meyer J S, Karacan I, Derman S, Yamamoto M. Normal human sleep: regional cerebral hemodynamics. Ann Neurol . 1980; 7 471-478
- 27b Lenzi P, Zoccoli G, Walker A M, Franzini C. Cerebral blood flow regulation in REM sleep: a model for flow-metabolism coupling. Archives Italiennes de Biologie . 1999; 137 165-179
- 27c Madsen P L, Holm S, Vorstrup S, Friberg L, Lassen N A, Wildschiodtz G. Human regional cerebral blood flow during rapid-eye-movement sleep. J Cerebral Blood Flow Metab . 191; 11 502-507
- 27d Fischer A Q, Taormina M A, Akhtar B, Chaudhary B A. The effect of sleep on intracranial hemodynamics: a transcranial Doppler study. J Child Neurol . 1991; 6 155-158
- 27e Madsen P L, Schmidt J F, Holm S, Vorstrup S, Lassen N A, Wildschiodtz G. Cerebral oxygen metabolism and cerebral blood flow in man during light sleep (stage 2). Brain Res . 1991; 557 217-220
- 27f Droste D W, Berger W, Schuler E, Krauss J K. Middle cerebral artery blood flow velocity in healthy persons during wakefulness and sleep: a transcranial Doppler study. Sleep . 1993; 16 603-609
- 27g Hoshi Y, Mizukami S, Tamura M. Dynamic features of hemodynamic and metabolic changes in the human brain during all-night sleep as revealed by near-infrared spectroscopy. Brain Res . 1994; 652 257-262
- 27h Hajak G, Klingelhofer J, Schulz-Varszegi M, Matzander G, Sander D, Conrad B, Ruther E. Relationship between cerebral blood flow velocities and cerebral electrical activity in sleep. Sleep . 1994; 17 11-19
- 27i Klingelhofer J, Hajak G, Matzander G, Schultz-Varszegi M, Sander D, Ruther E, Conrad B. Dynamics of cerebral blood flow velocities during normal human sleep. Clin Neurol Neurosurg . 1995; 97 142-148
- 28 Jennum P, Borgesen S E. Intracranial pressure and obstructive sleep apnea. Chest . 1989; 95 279-283
- 29 Netzer N, Werner P, Jochums I, Lehman M, Strohl K P. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas. Stroke . 1998; 29 87-93
- 30 Loeppky J A, Voyles W F, Eldridge M W, Sikes C W. Sleep apnea and autonomic cerebrovascular dysfunction. Sleep . 1987; 10 25-34
- 31 Balfors E M, Franklin K A. Impairment of cerebral perfusion during obstructive sleep apneas. Am J Respir Crit Care Med . 1994; 150 1587-1591
- 32 Diomedi M, Placidi F, Cupini L M, Bernardi G, Silvestrini M. Cerebral hemodynamic changes in sleep apnea syndrome and effect of continuous positive airway pressure treatment. Neurology . 1998; 51 1051-1056
- 33 Hayakawa T, Terashima M, Kayukawa Y, Ohta T, Okada T. Changes in cerebral oxygenation and hemodynamics during obstructive sleep apneas. Chest . 1996; 109 916-921
- 34 Marler J R, Price T R, Clark G L. Morning increase in onset of ischemic stroke. Stroke . 1989; 20 473-476
- 35 Angoli A, Manfredi M, Mossuto L, Piccinelli A. Rapport entre les rythmes hemeronyctaux de la tension arterielle et sa pathogenie de l'insuffisance vasculaire cerebrale. Rev Neurol (Paris) . 1975; 131 597-606
- 36 Partinen M, Palomaki H. Snoring and cerebral infarction. Lancet . 1985; 2 1325-1326
- 37 Palomaki H. Snoring and the risk of ischemic brain infarction. Stroke . 1991; 22 1021-1025
- 38 Sacco R L. Risk factors and outcomes for ischemic stroke. Neurology . 1995; S10-S14
- 39 Nieto F J, Young T B, Lind B K. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA . 2000; 283 1829-1836
- 40 Klingelhofer J, Hajak G, Sander D, Schulz-Varszegi M, Ruther E, Conrad B. Assessment of intracranial hemodynamics in sleep apnea syndrome. Stroke . 1992; 23 1427-1433
- 41 Bokinsky G, Miller M, Ault K, Husband P, Mitchell J. Spontaneous platelet activation and aggregation during obstructive sleep apnea and its response to therapy. Chest . 1995; 108 625-630
- 42 Wessendorf T E, Thilmann A F, Wang Y-M, Schreiber A, Konietzko N, Teschler H. Fibrinogen levels and obstructive sleep apnea in ischemic stroke. Am J Respir Crit Care Med . 2000; 162 2039-2042
- 43 Warlow C. Venous thromboembolism after stroke. Am Heart J . 1978; 96 283-285
- 44 Kamran S I, Downey D, Ruff R L. Pneumatic sequential compression reduces the risk of deep vein thrombosis in stroke patients. Neurology . 1998; 50 1683-1688
- 45 Wijdicks E FM, Scott J P. Pulmonary embolism associated with acute stroke. Mayo Clin Proc . 1997; 72 297-300
- 46 Rosenberg A, Bauer K. Does a prethrombotic state exist?. <~>If so, what is it? Am J Clin Nutr . 1992; (suppl) 7876-7885
- 47 Menon I S, Dewar H A. Increased fibrinolytic activity in venous blood of hemiplegic limbs. Br Med J . 1967; 2 613-615
- 48 Black P M, Crowell R M, Abbott W M. External pneumatic calf compression reduces deep venous thrombosis in patients with ruptured intracranial aneurysms. Neurosurgery . 1986; 18 25-28
- 49 Bromfield E, Reding M. Relative risk of deep venous thrombosis or pulmonary embolism poststroke based on ambulatory status. Neurorehabilitation . 1988; 2 51-57
- 50 Scmidt E V, Smirnov V E, Ryabova V S. Results of the seven-year prospective study of stroke patients. Stroke . 1988; 19 942-949
- 51 Harvey R, Roth E, Yarnold P. Deep vein thrombosis in stroke: the use of plasma D-dimer level as a screening test in the rehabilitation setting. Stroke . 1996; 27 1516-1520
- 52 Brandstater M E, Roth E J, Siebens H C. Venous thromboembolism in stroke: literature review and implications for clinical practice. Arch Phys Med Rehabil . 1992; 73 S379-S391
- 53 Savitz S I, Gupta G, Singh M, Rosenbaum D M. Antithrombotic and thrombolytic therapy for ischemic stroke. Clin Geriatric Med . 2001; 17(1) 149-161
- 54 International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet . 1997; 349 1569-1581
- 55 Koopman M, Prandoni P, Piovella F. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low molecular weight heparin administered at home. N Engl J Med . 1996; 334 682-687
- 56 Turpie A, Gent M, Cote R. A low-molecular-weight heparinoid compared with unfractionated heparin in the prevention of deep vein thrombosis in patients with acute ischemic stroke: a randomized, double-blind study. Ann Intern Med . 1992; 117 353-357
- 57 Agnelli G, Piovella F, Buoncristiani P. Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med . 1998; 339 80-85
- 58 Merli G J. Low-molecular-weight heparins versus unfractionated heparin in the treatment of deep vein thrombosis and pulmonary embolism. Am J Phys Med Rehabil . 2000; 79(suppl) S9-S16
- 59 Patel S C, Mody A. Cerebral hemorrhagic complications of thrombolytic therapy. Prog in Cardiovasc Dis . 1999; 42(3) 217-233
- 60 Teasell R W, McRae M, Heitzner J, Bhardwaj A, Finestone H. Frequency of videofluoroscopic modified barium swallow studies and pneumonia in stroke rehabilitation patients: a comparative study. Arch Phys Med Rehabil . 1999; 80 294-298
- 60a Veis S L, Logemann J A. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil . 1985; 66 372-375
- 61 Lugger K E. Dysphagia in the elderly stroke patient. J Neurosci Nursing . 1994; 26(2) 78-84
- 62 Meng N H, Wang T G, Lien I N. Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil . 2000; 79 170-175
- 63 Finestone H M. Safe feeding methods in stroke patients. Lancet . 2000; 355 1662-1663
- 64 O'Neill P A. Swallowing and prevention of complications. Br Med Bull . 2000; 56 457-65
- 65 Barer D H. Dysphagia in acute stroke. BMJ . 1987; 295 1137-1138
- 66 Splaingard M L, Hutchins B, Sulton L D, Chaudure G. Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil . 1988; 69 637-40
- 67 Hormann M. Swallowing disturbances. In: Hacke W, ed. Neurocritical Care Heidelberg, Berlin, New York: Springer-Verlag 1994: 157-161
- 67a Palmer J B, Drenran J C. Evaluation and treatment of swallowing impairments. Am Fam Physician . 2000; 61 2453-2462
- 68 Addington W R, Stephens R E, Gilliland K, Rodriguez M. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke. Arch Phys Med Rehabil . 1999; 80 150-154
- 69 Hamdy S, Rothwell J C, Aziz Q, Thompson D G. Organization and reorganization of human swallowing motor cortex: implications for recovery after stroke. Clin Sci . 2000; 98 51-157
- 69a Kim H, Chung C S, Lee K H, Robbins J. Aspiration subsequent to a pure medullary infarction. Arch Neurol . 2000; 57 478-483
- 70 Aviv J E. Clinical assessment of pharyngolaryngeal sensitivity. Am J Med . 2000; 108(4A) S68-S72
- 71 Nakagawa T, Sekizawa K, Nakajoh K, Tangi H, Arai H, Sasaki H. Silent cerebral infarction: a potential risk for pneumonia in the elderly. J Intern Med . 2000; 247 255-259
- 72 Grau A J, Buggle F, Schnitzler P, Spiel M, Lichy C, Hacke W. Fever and infection early after ischemic stroke. J Neurol Sci . 1999; 171 115-120
- 73 Teramoto S, Fukuchi Y. Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test. Arch Phys Med Rehabil . 2000; 81 1517-1519
- 74 Smithard D G, O'Neill P A, England R E. The natural history of dysphagia following a stroke. Dysphagia . 1997; 12 188-193
- 75 Miller R M, Chang M W. Advances in the management of dysphagia caused by stroke. Phys Med Rehabil Clin N Am . 1999; 10(4) 925-941
- 76 Arai T, Yasuda Y, Takaya T. ACE inhibitors and symptomless dysphagia. Lancet . 1998; 352 115-116
- 77 Colice G L, Matthay M A, Bass E, Matthay R A. Neurogenic pulmonary edema. Am Rev Respir Dis . 1984; 130 941-948
- 78 Smith W S, Matthay M A. Evidence for a hydrostatic mechanism in human neurogenic pulmonary edema. Chest . 1997; 111 1326-1333
- 79 Simon R P. Neurogenic pulmonary edema. Neurol Clin . 1993; 11(2) 309-323
- 80 Knudsen F, Jensen H P, Petersen P L. Neurogenic pulmonary edema:treatment with dobutamine. Neurosurgery . 1991; 29 269-270
- 81 Koskenvuo M, Kaprio J, Talakivi T, Partinen M, Heikkila K, Sarna S. Snoring as a risk factor for stroke in men. BMJ . 1987; 294 16-19
- 82 Neau J PH, Meurice J C, Paquereau J, Chavagnant J J, Ingrand P, Gil R. Habitual snoring as a risk factor for brain infarction. Acta Neurol Scand . 1995; 92 63-68