Dysphagia

, Volume 32, Issue 6, pp 767–776 | Cite as

Development of Pyriform Sinus Suctioning Programs for Aspiration Pneumonia Prevention During the Acute Stroke

  • Yuki Inui
  • Yayoi Kamakura
  • Junko Fukada
  • Masahiko Yoneda
  • Emiko Kataoka
  • Yasuko Usami
  • Miki Sugiura
  • Tetsuya Nagatani
  • Yukio Seki
  • Norikazu Hatano
  • Keizo Yasui
Original Article

Abstract

Aspiration due to dysphagia is a factor associated with pneumonia during acute stroke. In such cases, it is likely that secretions in the pyriform sinuses enter the laryngeal inlet. The present study was based on the idea that it is possible to reduce aspiration pneumonia by periodically suctioning and removing such secretions (pyriform sinus suctioning), a study was conducted in a single facility. The incidence of pneumonia as a dependent variable was compared between before (control) and after (intervention group) intervention with pyriform sinus suctioning as an independent variable. With a view of unifying the quality and frequency of intervention, two programs to: initially confirm the safety of such suctioning; subsequently enhance/evaluate knowledge and skills related to the procedure (educational); and specify conditions for the implementation and criteria for determining its appropriateness (practical), were developed. The study involved 33 (mean age: 74.6 ± 12.4) and 30 (80.0 ± 8.8) control and intervention group members, respectively, 25 (83.3%) of the latter were treated with pyriform sinus suctioning for 5 days after a stroke. Pneumonia developed in 7 (21.2%) and 2 (6.7%) of the former and latter, respectively. As individuals with a Japan Coma Scale (JCS) score of III or a midline shift on head CT tend to develop pharyngeal dysphagia, the patients were also divided into 2 groups to compare the incidence of pneumonia based on the risk level: low: Japan Coma Scale scores of I-II without a midline shift on head CT; and high: scores of II-III with it. In the latter, the incidence after intervention was markedly lower (p = 0.06, φ = 0.326), while the former did not show changes (p = 0.574, φ = 0.066), supporting the effectiveness of pyriform sinus suctioning to prevent aspiration pneumonia among patients with a low risk level.

Keywords

Acute stroke Aspiration pneumonia Pyriform sinus suctioning Programs Deglutition Deglutition disorders 

Notes

Acknowledgements

This work was supported by a grant-in-aid from The “YAMAJI FUMIKO NURSING RESEARCH FUND”.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Hilker R, Poetter C, Findeisen N, Sobesky J, Jacobs A, Neveling M, Heiss WD. Nosocomial pneumonia after acute stroke: implications for neurosurgical intensive care medicine. Stroke. 2003;34(4):975–81.CrossRefPubMedGoogle Scholar
  2. 2.
    Brogan E, Langdon C, Brookes K, Budgeon C, Blacker D. Dysphagia and factors associated with respiratory infections in the first week post stroke. Neuroepidemiology. 2014;43(2):140–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Teramoto S. Novel preventive and therapeutic strategy for post-stroke pneumonia. Expert Rev Neurother. 2009;9(8):1187–200.CrossRefPubMedGoogle Scholar
  4. 4.
    Aslanyan S, Weir CJ, Diener HC, Kaste M, Lees KR. Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial. Eur J Neurol. 2004;11(1):49–53.CrossRefPubMedGoogle Scholar
  5. 5.
    Dziewas R, Ritter M, Schilling M, Konrad C, Oelenberg S, Nabavi DG, Stögbauer F, Ringelstein EB, Lüdemann P. Pneumonia in acute stroke patients fed by nasogastric tube. J Neurol Neurosurg Psychiatry. 2004;75(6):852–6.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Smithard DG, O’Neill PA, England RE, Park CL, Wyatt R, Martin DF, Morris J. The Natural history of dysphagia following a stroke. Dysphagia. 1997;12(4):188–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factor at 6 months. Stroke. 1999;30(4):744–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Gordon C, Hewer RL, Wade TD. Dysphagia in acute stroke. Br Med J. 1987;295(6595):411–4.CrossRefGoogle Scholar
  9. 9.
    Paciaroni M, Mazzotta G, Corea F, Caso V, Venti M, Milia P, Silvestrelli G, Palmerini F, Parnetti L, Gallai V. Dysphagia following stroke. Eur Neurol. 2004;51(3):162–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, Wolfe CD. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32(6):1279–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Sørensen RT, Rasmussen RS, Overgaard K, Lerche A, Johansen AM. Lindhardt. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J Neurosci Nurs. 2013;45(3):139–46.CrossRefPubMedGoogle Scholar
  12. 12.
    Palazzo P, Brooks A, James D, Moore R, Alexandrov AV, Alexandrov AW. Risk of pneumonia associated with zero-degree head positioning in acute ischemic stroke patients treated with intravenous tissue plasminogen activator. Brain Behav. 2016;6(2):e00425.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, Oschatz E. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. AJR Am J Roentgenol. 2002;178(2):393–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Belafsky PC, Mehdizadeh OB, Ledgerwood L, Kuhn M. Evaluation of hypopharyngeal suction to eliminate aspiration: the Retro-Esophageal Suction (REScue) catheter. Dysphagia. 2015;30(1):74–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Engeseihaisikkankenkyuukai. Diagnosis and treatment for aspiration pulmonary disease. Phizer Inc. 2003, Japan.Google Scholar
  16. 16.
    Sellars C, Bowie L, Bagg J, Sweeney MP, Miller H, Tilston J, Langhorne P, Stott DJ. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke. 2007;38(8):2284–91.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Yuki Inui
    • 1
  • Yayoi Kamakura
    • 1
  • Junko Fukada
    • 1
  • Masahiko Yoneda
    • 1
  • Emiko Kataoka
    • 2
  • Yasuko Usami
    • 2
  • Miki Sugiura
    • 2
  • Tetsuya Nagatani
    • 3
  • Yukio Seki
    • 3
  • Norikazu Hatano
    • 3
  • Keizo Yasui
    • 4
  1. 1.Graduate School of Nursing & HealthAichi Prefectural UniversityNagoya-ShiJapan
  2. 2.Department of NursingJapanese Red Cross Nagoya Daini HospitalNagoya-ShiJapan
  3. 3.Department of NeurosurgeryJapanese Red Cross Nagoya Daini HospitalNagoya-ShiJapan
  4. 4.Department of NeurologyJapanese Red Cross Nagoya Daini HospitalNagoya-ShiJapan

Personalised recommendations