Abstract
Pneumonia is a frequent complication in patients with acute and subacute stroke. Hence, pneumonia prevention is a prominent issue. Although previous reports have demonstrated the efficacy of various swallowing therapies in preventing pneumonia, details of their efficacy profiles have not been fully elucidated. This study aimed to compare the effectiveness of behavior interventions （BI）, metoclopramide （MCP）, prophylactic antibiotics （PA）, and pharyngeal electrical stimulation （PES） in preventing pneumonia between patients with acute to subacute stroke and a control group （N）. A network meta-analysis of randomized controlled trials was conducted. The primary endpoint was the frequency of pneumonia. Integrated estimates were expressed as odds ratios （ORs） and 95％ credible intervals （CIs）. Five studies （n＝1,179） were included in the analysis. The frequency of pneumonia was significantly lower in group MCP than in groups BI, PA, and N （OR ［95％ CI］ of MCP vs. BI, PA vs. MCP, and MCP vs. N: 0.127 ［0.018 to 0.450］, 24.15 ［3.653 to 84.50］, and 0.081 ［0.013 to 0.273］, respectively）. There was no significant difference in the frequency of pneumonia between each treatment pair among the BI, PA, PES, and N groups. MCP showed good pneumonia prophylaxis in patients with acute to subacute stroke compared to BI or PA. Further clinical studies to verify the efficacy and safety profile of MCP in preventing pneumonia are warranted.
