One of the most distressing situations for stroke patients is the addition of a lung infection (pneumonia) to their illness. Aspiration pneumonia can occur as a result of factors such as dysphagia ( swallowing disorder ), aspiration (escape of food or stomach contents into the windpipe and lungs), and weakening of the person’s immune system after a stroke. The risk is highest in the first 2 weeks after stroke. Bacteria that pass through the mouth to the trachea and lungs, and the stomach acid to damage the trachea and bronchi by passing through, paves the way for the development of infection.
Aspiration can be divided into three: it can develop during chewing, during swallowing, and after swallowing is complete. If all of the food cannot be transferred to the esophagus by swallowing, parts of the mouth and pharynx may escape into the trachea while the patient is breathing. Treatment approaches differ according to the mechanism, so videofluoroscopy or endoscopic examinations should be performed to differentiate. We talked about these techniques in our swallowing disorder article. Aspiration may not cause coughing in stroke patients (silent aspiration). Objective assessments are therefore necessary.
How is aspiration pneumonia prevented?
In order to prevent aspiration pneumonia, dysphagia should be recognized early and measures should be taken to reduce the volume and frequency of aspiration. Increasing the sensation of the larynx and pharynx, developing protective mechanisms such as coughing, and restoring the swallowing function with the brain’s relearning (plasticity) ability .are approaches to prevent aspiration. Treatment of stroke patients in a specialized unit reduces the risk of aspiration pneumonia by early detection of dysphagia by screening, regulating the consistency of food, feeding with a nasogastric tube (NG) or PEG when necessary, and early initiation of body movements (mobilization). It is beneficial to reduce the number of bacteria at risk for pneumonia in the mouth with oral care (1). Stroke not only impairs swallowing functions, but also impairs the function of the lower esophagus and stomach. The contents in the stomach may not fully pass into the intestines, reflux (gastroesophageal reflux) and vomiting may occur. Anti-vomiting medication may reduce the risk of pneumonia (2). We know that some blood pressure medications cause cough as a side effect.