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Stroke-related pulmonary complications and abnormal respiratory patterns

Julio A Chalela, MD
Section Editor
Jose Biller, MD, FACP, FAAN, FAHA
Deputy Editor
John F Dashe, MD, PhD


Medical complications of acute ischemic stroke are common and often lead to poor clinical outcomes. The frequency of these complications must be recognized so that preventive strategies and appropriate treatment are employed.

The major pulmonary complications of acute stroke will be reviewed here. Other medical complications of acute stroke are discussed separately. (See "Medical complications of stroke" and "Cardiac complications of stroke".)


Pneumonia is one of the most common respiratory complications of acute stroke, occurring in about 5 to 9 percent of patients [1-3]. The incidence of stroke-related pneumonia appears to be higher in patients with acute ischemic stroke admitted to a neurologic intensive care unit and in those who require nasogastric tube feeding (21 and 44 percent, respectively) [4,5].

Patients with stroke-related pneumonia have a higher mortality and a poorer long-term outcome when compared with patients without pneumonia [2,3]. Pneumonia is the most common cause of fever within the first 48 hours of acute stroke, and it is the most common medical complication two to four weeks after a supratentorial ischemic infarction [1,6,7]. In addition, retrospective data suggest that pneumonia and respiratory illness are the most frequent diagnoses leading to hospital readmission in stroke survivors in the first five years after ischemic stroke [8].

In a prospective study of 412 patients with acute stroke, independent risk factors for in-hospital pneumonia were age >65 years, dysarthria or no speech due to aphasia, severe poststroke disability, cognitive impairment, and an abnormal water swallow test [9]. In an earlier prospective study of 124 patients with acute stroke treated in the intensive care unit, risk factors were mechanical ventilation, abnormal chest radiograph on admission, and dysphagia [4]. In patients requiring nasogastric feeding, independent risk factors for pneumonia were facial palsy and deceased level of consciousness [5].

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Literature review current through: Nov 2017. | This topic last updated: Mar 02, 2016.
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