pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2020-30-4-485-492pulmo-2155Research ArticleОБЗОРЫREVIEWСиндром дыхательной недостаточности при остром инсульте: новые подходы к диагностикеThe syndrome of respiratory failure in acute stroke: new diagnostic approachesЧучалинА. Г.ChuchalinA. G.

Чучалин Александр Григорьевич – доктор медицинских наук, профессор, академик Российской академии наук, заведующий кафедрой госпитальной терапии педиатрического факультета

117997, Москва, ул. Островитянова, 1

Aleksandr G. Chuchalin, Doctor of Medicine, Professor, Academician of Russian Science Academy, Head of Department of Hospital Internal Medicine. Pediatric faculty

ul. Ostrovityanova 1, Moscow, 117997

chuchalin@inbox.ruКимТ. Г.КimT. G.

Ким Татьяна Геннадиевна – ассистент кафедры госпитальной терапии педиатрического факультета

117997, Москва, ул. Островитянова, 1

Tat'yana G. Kim, assistant of the Department of hospital therapy of the pediatric faculty

ul. Ostrovityanova 1, Moscow, 117997

tnkim@mail.ruМартыновМ. Ю.ShogenovaL. V.

Мартынов Михаил Юрьевич – член-корреспондент Российской академии наук, профессор кафедры неврологии, нейрохирургии и медицинской генетики

117997, Москва, ул. Островитянова, 1

Lyudmila V. Shogenova, Сandidate of Medicine, Associate Professor, Department of Hospital Therapy, Pediatric Faculty

ul. Ostrovityanova 1, Moscow, 117997

m-martin@inbox.ruГусевЕ. И.MartynovM. Yu.

Гусев Евгений Иванович – доктор медицинских наук, профессор, академик Российской академии наук, заведующий кафедрой неврологии, нейрохирургии и медицинской генетики

117997, Москва, ул. Островитянова, 1

Michail Yu. Martynov, corresponding member of the Russian Academy of Sciences, Professor of the Department of neurology, neurosurgery and medical genetics

ul. Ostrovityanova 1, Moscow, 117997

e.i.gusev@mail.ruШогеноваЛ. В.GusevE. I.

Шогенова Людмила Владимировна – кандидат медицинских наук, доцент кафедры госпитальной терапии педиатрического факультета

117997, Москва, ул. Островитянова, 1

Eugeniу I. Gusev, Doctor of Medicine, Professor, Academician of Russian Science Academy, Head of Department of neurology, neurosurgery and medical genetics, Faculty of General Medicine

ul. Ostrovityanova 1, Moscow, 117997

Luda_Shog@list.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской ФедерацииРоссияN.I.Pirogov Federal Russian National Research Medical University, Healthcare Ministry of RussiaRussian Federation202017102020304485492Copyright © Чучалин А.Г., Ким Т.Г., Мартынов М.Ю., Гусев Е.И., Шогенова Л.В., 20202020Чучалин А.Г., Ким Т.Г., Мартынов М.Ю., Гусев Е.И., Шогенова Л.В.Chuchalin A.G., Кim T.G., Shogenova L.V., Martynov M.Y., Gusev E.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/2155

В статье представлен обзор проблемы дыхательной недостаточности (ДН) у пациентов острым инсультом, ее влияние на клиническое течение, смертность, прогноз. Рассмотрены распространенность, ведущие патофизиологические факторы, клинические особенности, методы диагностики. Инсульт является третьей ведущей причиной смерти во всем мире. Пациенты, перенесшие инсульт, погибают от осложнений, с которыми они сталкиваются. Нарушения функции дыхательной системы и респираторные осложнения часто возникают при развитии инсульта. Синдром ДН различной степени выраженности сопровождает развитие инсульта в 44–90 % случаев, часто остается недооцененным, недиагностированным вследствие клинической особенности пациентов данной категории. Характер этих нарушений зависит от тяжести и локализации неврологического повреждения. Нарушения регуляции дыхания, механики и паттерна дыхания являются частыми проявлениями ДН и могут привести к нарушениям газообмена и необходимости респираторной поддержки. Ведущим симптом является гипоксемия, которая также носит скрытый характер, и выявляется при исследовании газового состава артериальной крови. Инсульт может привести к нарушению дыхания во сне, таким как центральное или обструктивное апноэ сна. Нарушение дыхания во сне также может играть определенную роль в патогенезе церебрального инфаркта. Венозная тромбоэмболия, нарушения глотания, аспирация и пневмония являются одними из наиболее распространенных респираторных осложнений инсульта. Нейрогенный отек встречается реже, но протекает достаточно драматично. Поэтому ранняя диагностика, профилактика и лечение играют важную роль в снижении летальности и улучшении реабилитационного потенциала.

The article presents an overview of the problem of respiratory failure in patients with acute stroke, its prevalence, leading pathophysiological factors, clinical features, and diagnostic methods. Stroke is the third leading cause of death worldwide. Stroke survivors often experience medical complications that may be the direct cause of mortality. The syndrome of respiratory failure and respiratory complication are common after stroke. The syndrome of respiratory failure syndrome of varying severity is following after stroke in 44 – 90%, often remains undervalued, undiagnosed, due to the clinical features of this category of patients. The nature of these disorders depends on the severity and site of neurological injury. Abnormality of breathing control, respiratory mechanics, and breathing pattern are common and may lead to gas exchange abnormalities or the need for respiratory support. The leading symptom is hypoxemia, which is often hidden, and may be detected by examining of arterial blood gasses (PaO2, PCO2). 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 but may be very dramatic. Therefore, early diagnosis, prevention and treatment are important in reducing mortality and improving functional rehabilitation.

синдром дыхательной недостаточностиострый инсультгипоксемияаспирацияпневмониярасстройство дыхания во сневенозная тромбэмболияrespiratory failure syndromeacute strokehypoxemiaaspirationpneumoniasleep-related breathing disordersvenous thromboembolismReferencesПирадов М.А., Максимова М.Ю., Танашян М.М. Инсульт: пошаговая инструкция. Руководство для врачей. М.: ГЭОТАР-Медиа; 2019.Piradov M.A., Maksi - mova M.Yu., Tanashyan M.M. [Stroke: step by step instructions. Guideline for doctors]. Moscow: GEOTAR-Media; 2019 (in Russian).Global Health Estimates 2016: Deaths by cause, age, sex, by country and by region, 2000–2016. Geneva, World Health Organization; 2018. Available at: https://www.who.int/healthinfo/global_burden_disease/estimates/en/Global Health Estimates 2016: Deaths by cause, age, sex, by country and by region, 2000–2016. Geneva, World Health Organization; 2018. Available at: https://www.who.int/healthinfo/global_burden_disease/estimates/en/Donnan G.A., Fisher M., Macleod M., Davis S.M. Stroke. Lancet. 2008; 371 (9624): 1612–1623. DOI: 10.1016/S0140-6736(08)60694-7.Donnan G.A., Fisher M., Macleod M., Davis S.M. Stroke. Lancet. 2008; 371 (9624): 1612–1623. DOI: 10.1016/S0140-6736(08)60694-7.Гусев Е.И., Скворцова В.И., Стаховская Л.В. и др. Эпидемиология инсульта в России. Consilium Medi cum. 2003; 5 (5, Прил.): 7–11. Доступно на: http://old.consiliummedicum.com/media/consilium/03_05c/5.shtmlGusev E.I., Skvortsova V.I., Stakhovskaya L.V. et al. [Epidemiology of stroke in Russia]. Consilium Medicum. 2003; 5 (5, Suppl.): 7–11. Available at: http://old.consilium-medicum.com/media/consilium/03_05c/5.shtml (in Russia).Kumar S., Selim M.H., Caplan L.R. Medical complications after stroke. 2010; 9 (1): 105–110. DOI: 10.1016/S1474-4422(09)70266-2.Kumar S., Selim M.H., Caplan L.R. Medical complications after stroke. 2010; 9 (1): 105–110. DOI: 10.1016/S1474-4422(09)70266-2.Pelosi P., Ferguson N.D., Frutos-Vivar F. et al. Management and outcome of mechanically ventilated neurologic patients. Crit .Care Med. 2011; 39 (6): 1482–1492. DOI: 10.1097/CCM.0b013e31821209a8.Pelosi P., Ferguson N.D., Frutos-Vivar F. et al. Management and outcome of mechanically ventilated neurologic patients. Crit .Care Med. 2011; 39 (6): 1482–1492. DOI: 10.1097/CCM.0b013e31821209a8.Bösel J. Use and timing of tracheostomy after severe stroke. Stroke. 2017; 48 (9): 2638–2643. DOI: 10.1161/STROKEAHA.117.017794.Bösel J. Use and timing of tracheostomy after severe stroke. Stroke. 2017; 48 (9): 2638–2643. DOI: 10.1161/STROKEAHA.117.017794.Robba C., Bonatti, G., Battaglini D. et al. Mechanical ventilation in patients with acute ischaemic stroke: from pathophysiology to clinical practice. Crit. Care. 2019; 23: 388. DOI: 10.1186/s13054-019-2662-8.Robba C., Bonatti, G., Battaglini D. et al. Mechanical ventilation in patients with acute ischaemic stroke: from pathophysiology to clinical practice. Crit. Care. 2019; 23: 388. DOI: 10.1186/s13054-019-2662-8.Rochester C.L., Mohsenin V. Respiratory complications of stroke. Semin. Respir. Crit. Care Med. 2002; 23 (3): 248–260. DOI: 10.1055/s-2002-33033.Rochester C.L., Mohsenin V. Respiratory complications of stroke. Semin. Respir. Crit. Care Med. 2002; 23 (3): 248–260. DOI: 10.1055/s-2002-33033.Howard R.S., Rudd A.G., Wolfe C.D., Williams A.J. Pathophysiological and clinical aspects of breathing after stroke. Postgrad. Med. J. 2001; 77 (913): 700–702. DOI: 10.1136/pmj.77.913.700.Howard R.S., Rudd A.G., Wolfe C.D., Williams A.J. Pathophysiological and clinical aspects of breathing after stroke. Postgrad. Med. J. 2001; 77 (913): 700–702. DOI: 10.1136/pmj.77.913.700.Пирадов М.А., Гулевская Т.С., Гнедовская Е.В., Рябинкина Ю.В. Экстрацеребральная патология и синдром полиорганной недостаточности притяжелых формах инсульта. Русский медицинский журнал. 2006; 14 (23): 1645–1649.Piradov M.A., Gulevskaya T.S., Gnedovskaya E.V., Ryabinkina Yu.V. [Extracerebral pathology and multiple organ failure syndrome in severe forms of stroke]. Russkiy meditsinskiy zhurnal. 2006; 14 (23): 1645– 1649 (in Russian).Rowat A.M., Dennis M.S., Wardlaw J.M. Hypoxaemia in acute stroke is frequent and worsens outcome. Cerebrovasc. Dis. 2006; 21 (3): 166–172. DOI: 10.1159/000090528.Rowat A.M., Dennis M.S., Wardlaw J.M. Hypoxaemia in acute stroke is frequent and worsens outcome. Cerebrovasc. Dis. 2006; 21 (3): 166–172. DOI: 10.1159/000090528.Von Euler C. Brain stem mechanisms for generation and control of breathing pattern. In: Fishman A.P., ed. Handbook of Physiology Section 3 Volume 11: Control of Breathing Part 1 the Respiratory System (V.2). 2nd Ed. Bethesda, MD: American Physiologic Society; 1986: 1–68. DOI: 10.1002/cphy.cp030201.Von Euler C. Brain stem mechanisms for generation and control of breathing pattern. In: Fishman A.P., ed. Handbook of Physiology Section 3 Volume 11: Control of Breathing Part 1 the Respiratory System (V.2). 2nd Ed. Bethesda, MD: American Physiologic Society; 1986: 1–68. DOI: 10.1002/cphy.cp030201.Frank J.I., Hanley D.F. Abnormal breathing patterns. In: Hacke W., Hanley D.F., Einhäupl K.M. et al. Neurocritical Care. Berlin, Heidelberg, New York, Tokio: SpringerVerlag; 1994: 366–373. Available at: https://link.springer.com/book/10.1007%2F978-3-642-87602-8Frank J.I., Hanley D.F. Abnormal breathing patterns. In: Hacke W., Hanley D.F., Einhäupl K.M. et al. Neurocritical Care. Berlin, Heidelberg, New York, Tokio: SpringerVerlag; 1994: 366–373. Available at: https://link.springer.com/book/10.1007%2F978-3-642-87602-8Lee M.C., Klassen A.C., Resch J.A. Respiratory pattern disturbances in ischemic cerebral vascular disease. Stroke. 1974; 5 (5): 612–616. DOI: 10.1161/01.str.5.5.612.Lee M.C., Klassen A.C., Resch J.A. Respiratory pattern disturbances in ischemic cerebral vascular disease. Stroke. 1974; 5 (5): 612–616. DOI: 10.1161/01.str.5.5.612.Chalela J.A., Kasner S.E. Cardiac and respiratory complications of stroke. UpToDate. 2001. Available at: http://www.uptodate.com [Accessed: September 2001].Chalela J.A., Kasner S.E. Cardiac and respiratory complications of stroke. UpToDate. 2001. Available at: http://www.uptodate.com [Accessed: September 2001].Fluck D.C. Chest movements in hemiplegia. Clin. Sci. 1966; 31 (3): 383–388.Fluck D.C. Chest movements in hemiplegia. Clin. Sci. 1966; 31 (3): 383–388.Nachtmann A., Selder M., Rose G. et al. Cheyne-Stokes respiration in ischemic stroke. Neurology. 1995; 45 (4): 820–821. DOI: 10.1212/wnl.45.4.820.Nachtmann A., Selder M., Rose G. et al. Cheyne-Stokes respiration in ischemic stroke. Neurology. 1995; 45 (4): 820–821. DOI: 10.1212/wnl.45.4.820.Plum F. Mechanisms of “central” hyperventilation. Ann. Neurol. 1982; 11 (6): 636–637. DOI: 10.1002/ana.410110615.Plum F. Mechanisms of “central” hyperventilation. Ann. Neurol. 1982; 11 (6): 636–637. DOI: 10.1002/ana.410110615.Rodriquez M., Baele P.L., Marsh H.M., Okazaki H. Central neurogenic hyperventilation in an awake patient with brainstem astrocytoma. Ann. Neurol. 1982; 11 (6): 625–628. DOI: 10.1002/ana.410110612.Rodriquez M., Baele P.L., Marsh H.M., Okazaki H. Central neurogenic hyperventilation in an awake patient with brainstem astrocytoma. Ann. Neurol. 1982; 11 (6): 625–628. DOI: 10.1002/ana.410110612.Devereaux M.W., Keane J.R., Davis R.L. Automatic respiratory failure: Report of two cases with pathologic study of one. Arch. Neurol. 1973; 29 (1): 46–52. DOI: 10.1001/archneur.1973.00490250064007.Devereaux M.W., Keane J.R., Davis R.L. Automatic respiratory failure: Report of two cases with pathologic study of one. Arch. Neurol. 1973; 29 (1): 46–52. DOI: 10.1001/archneur.1973.00490250064007.Severinghaus J.W., Mitchell R.A. Ondine’s curse – failure of respiratory center automaticity while awake. Clin. Res. 1962; 10: 122.Severinghaus J.W., Mitchell R.A. Ondine’s curse – failure of respiratory center automaticity while awake. Clin. Res. 1962; 10: 122.Bogousslavsky J., Khurana R., Deruaz J.P. et al. Res - piratory failure and unilateral caudal brainstem infarction. Ann. Neurol. 1990; 28 (5): 668–673. DOI: 10.1002/ana.410280511.Bogousslavsky J., Khurana R., Deruaz J.P. et al. Res - piratory failure and unilateral caudal brainstem infarction. Ann. Neurol. 1990; 28 (5): 668–673. DOI: 10.1002/ana.410280511.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 (9): 1765–1772. DOI: 10.1161/01.str.28.9.1765.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 (9): 1765–1772. DOI: 10.1161/01.str.28.9.1765.Lenzi P., Zoccoli G., Walker A.M., Franzini C. Cerebral blood flow regulation in REM sleep: a model for flowmetabolism coupling. Arch. Ital. Biol. 1999; 137 (2–3): 165–179.Lenzi P., Zoccoli G., Walker A.M., Franzini C. Cerebral blood flow regulation in REM sleep: a model for flowmetabolism coupling. Arch. Ital. Biol. 1999; 137 (2–3): 165–179.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 (2): 155–158. DOI: 10.1177/088307389100600212.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 (2): 155–158. DOI: 10.1177/088307389100600212.Sakai F., Meyer J.S., Karacan I. et al. Normal human sleep: regional cerebral hemodynamics. Ann. Neurol. 1980; 7 (5): 471–478. DOI: 10.1002/ana.410070514.Sakai F., Meyer J.S., Karacan I. et al. Normal human sleep: regional cerebral hemodynamics. Ann. Neurol. 1980; 7 (5): 471–478. DOI: 10.1002/ana.410070514.Johnson K.G., Johnson D.C. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J. Clin. Sleep Med. 2010; 6 (2): 131–137.Johnson K.G., Johnson D.C. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J. Clin. Sleep Med. 2010; 6 (2): 131–137.Dyken M.E., Somers V.K., Yamada T. et al. Investigating the relationship between stroke and obstructive sleep apnea. Stroke. 1996; 27 (3): 401–407. DOI: 10.1161/01.str.27.3.401.Dyken M.E., Somers V.K., Yamada T. et al. Investigating the relationship between stroke and obstructive sleep apnea. Stroke. 1996; 27 (3): 401–407. DOI: 10.1161/01.str.27.3.401.Klingelhöfer J., Hajak G., Matzander G. et al. Dynamics of cerebral blood flow velocities during normal human sleep. Clin. Neurol. Neurosurg. 1995; 97 (2): 142–148. DOI: 10.1016/0303-8467(95)00030-N.Klingelhöfer J., Hajak G., Matzander G. et al. Dynamics of cerebral blood flow velocities during normal human sleep. Clin. Neurol. Neurosurg. 1995; 97 (2): 142–148. DOI: 10.1016/0303-8467(95)00030-N.Jennum P., Borgesen S.E. Intracranial pressure and obstructive sleep apnea. Chest. 1989; 95 (2): 279–283. DOI: 10.1378/chest.95.2.279.Jennum P., Borgesen S.E. Intracranial pressure and obstructive sleep apnea. Chest. 1989; 95 (2): 279–283. DOI: 10.1378/chest.95.2.279.Sandberg O., Frankllin K.A., Bocht G. et al. Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study. Eur. Respir. J. 2001; 18 (4): 630–634. DOI: 10.1183/09031936.01.00070301.Sandberg O., Frankllin K.A., Bocht G. et al. Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study. Eur. Respir. J. 2001; 18 (4): 630–634. DOI: 10.1183/09031936.01.00070301.Kim H., Im S., Park J.I. et al. Improvement of cognitive function after continuous positive airway pressure treatment for subacute stroke patients with obstructive sleep apnea: A randomized controlled trial. Brain Sci. 2019; 9 (10): 252. DOI: 10.3390/brainsci9100252.Kim H., Im S., Park J.I. et al. Improvement of cognitive function after continuous positive airway pressure treatment for subacute stroke patients with obstructive sleep apnea: A randomized controlled trial. Brain Sci. 2019; 9 (10): 252. DOI: 10.3390/brainsci9100252.Netzer N., Werner P., Jochums I. et al. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas. Stroke. 1998; 29 (1): 87–93. DOI: 10.1161/01.str.29.1.87.Netzer N., Werner P., Jochums I. et al. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas. Stroke. 1998; 29 (1): 87–93. DOI: 10.1161/01.str.29.1.87.Diomedi M., Placidi F., Cupini L.M. et al. Cerebral hemodynamic changes in sleep apnea syndrome and effect of continuous positive airway pressure treatment. Neurology. 1998; 51 (4): 1051–1056. DOI: 10.1212/wnl.51.4.1051.Diomedi M., Placidi F., Cupini L.M. et al. Cerebral hemodynamic changes in sleep apnea syndrome and effect of continuous positive airway pressure treatment. Neurology. 1998; 51 (4): 1051–1056. DOI: 10.1212/wnl.51.4.1051.Hayakawa T., Terashima M., Kayukawa Y. et al. Changes in cerebral oxygenation and hemodynamics during obstructive sleep apneas. Chest. 1996; 109 (4): 916–921. DOI: 10.1378/chest.109.4.916.Hayakawa T., Terashima M., Kayukawa Y. et al. Changes in cerebral oxygenation and hemodynamics during obstructive sleep apneas. Chest. 1996; 109 (4): 916–921. DOI: 10.1378/chest.109.4.916.Marler J.R., Price T.R., Clark G.L. et al. Morning increase in onset of ischemic stroke. Stroke. 1989; 20 (4): 473–476. DOI: 10.1161/01.str.20.4.473.Marler J.R., Price T.R., Clark G.L. et al. Morning increase in onset of ischemic stroke. Stroke. 1989; 20 (4): 473–476. DOI: 10.1161/01.str.20.4.473.Nieto F.J., Young T.B., Lind B.K. et al. Association of sleepdisordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA. 2000; 283 (14): 1829–1836. DOI: 10.1001/jama.283.14.1829.Nieto F.J., Young T.B., Lind B.K. et al. Association of sleepdisordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA. 2000; 283 (14): 1829–1836. DOI: 10.1001/jama.283.14.1829.Wessendorf T.E., Teschler H., Wang Y.M. et al. Sleep-disordered breathing with first-ever stroke. J. Neurol. 2000; 247: 41–47. DOI: 10.1007/pl00007787.Wessendorf T.E., Teschler H., Wang Y.M. et al. Sleep-disordered breathing with first-ever stroke. J. Neurol. 2000; 247: 41–47. DOI: 10.1007/pl00007787.Quan S.F., Howard B.V., Iber C. et al. The Sleep Heart Health study: design, rationale, and methods. Sleep. 1998; 20 (12): 1077–1085. DOI: 10.1093/sleep/20.12.1077.Quan S.F., Howard B.V., Iber C. et al. The Sleep Heart Health study: design, rationale, and methods. Sleep. 1998; 20 (12): 1077–1085. DOI: 10.1093/sleep/20.12.1077.Hannawi Y., Hannawi B., Rao C.P.V. et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc. Dis. 2013; 35: 430–443. DOI: 10.1159/000350199.Hannawi Y., Hannawi B., Rao C.P.V. et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc. Dis. 2013; 35: 430–443. DOI: 10.1159/000350199.Lugger K.E. Dysphagia in the elderly stroke patient. J. Neuro sci. Nursing. 1994; 26 (2): 78–84. DOI: 10.1097/01376517-199404000-00005.Lugger K.E. Dysphagia in the elderly stroke patient. J. Neuro sci. Nursing. 1994; 26 (2): 78–84. DOI: 10.1097/01376517-199404000-00005.Gordon C., Hewer R.L., Wade D.T. Dysphagia in acute stroke. Br. Med. J. 1987; 295 (6595): 411–414. DOI: 10.1136/bmj.295.6595.411.Gordon C., Hewer R.L., Wade D.T. Dysphagia in acute stroke. Br. Med. J. 1987; 295 (6595): 411–414. DOI: 10.1136/bmj.295.6595.411.Teasell R.W., McRae M., Heitzner J. et al. Frequency of videofluoroscopic modified barium swallow studies and pneumonia in stroke rehabilitation patients: a comparative study. Arch. Phys. Med. Rehabil. 1999; 80 (3): 294–298. DOI: 10.1016/s0003-9993(99)90140-5.Teasell R.W., McRae M., Heitzner J. et al. Frequency of videofluoroscopic modified barium swallow studies and pneumonia in stroke rehabilitation patients: a comparative study. Arch. Phys. Med. Rehabil. 1999; 80 (3): 294–298. DOI: 10.1016/s0003-9993(99)90140-5.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. DOI: 10.1016/s0003-9993(99)90112-0.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. DOI: 10.1016/s0003-9993(99)90112-0.Nakagawa T., Sekizawa K., Nakajoh K. et al. Silent cerebral infarction: a potential risk for pneumonia in the elderly. J. Intern. Med. 2000; 247 (2): 255–259. DOI: 10.1046/j.1365-2796.2000.00599.x.Nakagawa T., Sekizawa K., Nakajoh K. et al. Silent cerebral infarction: a potential risk for pneumonia in the elderly. J. Intern. Med. 2000; 247 (2): 255–259. DOI: 10.1046/j.1365-2796.2000.00599.x.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 (2): 170–175. DOI: 10.1097/00002060-200003000-00010.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 (2): 170–175. DOI: 10.1097/00002060-200003000-00010.O’Neill P.A. Swallowing and prevention of complications. Br. Med. Bull. 2000; 56 (2): 457–465. DOI: 10.1258/0007142001903094.O’Neill P.A. Swallowing and prevention of complications. Br. Med. Bull. 2000; 56 (2): 457–465. DOI: 10.1258/0007142001903094.Asehnoune K., Roquilly A., Cinotti R. Respiratory management in patients with severe brain injury. Crit. Care. 2018; 22 (1): 76. DOI: 10.1186/s13054-018-1994-0.Asehnoune K., Roquilly A., Cinotti R. Respiratory management in patients with severe brain injury. Crit. Care. 2018; 22 (1): 76. DOI: 10.1186/s13054-018-1994-0.Colice G.L., Matthay M.A., Bass E., Matthay R.A. Neurogenic pulmonary edema. Am. Rev. Respir. Dis. 1984; 130 (5): 941–948.Colice G.L., Matthay M.A., Bass E., Matthay R.A. Neurogenic pulmonary edema. Am. Rev. Respir. Dis. 1984; 130 (5): 941–948.Simon R.P. Neurogenic pulmonary edema. Neurol. Clin. 1993; 11 (2): 309–323.Simon R.P. Neurogenic pulmonary edema. Neurol. Clin. 1993; 11 (2): 309–323.Warlow C. Venous thromboembolism after stroke. Am. Heart J. 1978; 96 (3): 283–285. DOI: 10.1016/0002-8703(78)90037-6.Warlow C. Venous thromboembolism after stroke. Am. Heart J. 1978; 96 (3): 283–285. DOI: 10.1016/0002-8703(78)90037-6.Menon I.S., Dewar H.A. Increased fibrinolytic activity in venous blood of hemiplegic limbs. Br. Med. J. 1967; 2: 613. DOI: 10.1136/bmj.2.5552.613.Menon I.S., Dewar H.A. Increased fibrinolytic activity in venous blood of hemiplegic limbs. Br. Med. J. 1967; 2: 613. DOI: 10.1136/bmj.2.5552.613.Scmidt E.V., Smirnov V.E., Ryabova V.S. Results of the seven-year prospective study of stroke patients. Stroke. 1988; 19 (8): 942–949. DOI: 10.1161/01.str.19.8.942.Scmidt E.V., Smirnov V.E., Ryabova V.S. Results of the seven-year prospective study of stroke patients. Stroke. 1988; 19 (8): 942–949. DOI: 10.1161/01.str.19.8.942.Wijdicks E.F.M., Scott J.P. Pulmonary embolism associated with acute stroke. Mayo Clin. Proc. 1997; 72 (4): 297–300. DOI: 10.4065/72.4.297.Wijdicks E.F.M., Scott J.P. Pulmonary embolism associated with acute stroke. Mayo Clin. Proc. 1997; 72 (4): 297–300. DOI: 10.4065/72.4.297.

The authors declare that there are no conflicts of interest present.