The Metoclopramide and selective oral decontamination for Avoiding Pneumonia after Stroke trial

Recent updates

Recent updates

The funding for the MAPS-2 clinical trial has been approved

Chief Investigator:

  • Professor Christine Roffe


  • University Hospitals of North Midlands NHS Trust



Stroke is the second most common cause of death worldwide and the fourth most common in the UK, with approximately 152,000 strokes per annum in the UK. Mortality for stroke in the UK is estimated at 7% (1 in 14 deaths are due to stroke). Half of all stroke survivors are left dependent on others for everyday activities, making stroke the largest cause of complex disability.

Stroke associated pneumonia

Pneumonia is a common complication of stroke and is associated with high mortality, long length of stay and lower potential for function recovery.  Stroke patients who have swallowing problems are more likely to develop pneumonia than stroke patients with normal swallowing function.  Patients who require nasogastric feeding are at highest risk of pneumonia.


Thirty-one percent of stroke-related deaths are caused by pneumonia, while only 10% are directly due to due to neurological deficits. While thrombolysis improves neurological impairment and significantly reduces post-stroke disability, it has no impact on survival. The only interventions that have been shown to affect both mortality and morbidity after stroke address complications rather than the neurological injury itself.  Pneumonia weakens patients, and affects their ability to engage with therapy.  Prevention of pneumonia as the most common severe complication of stroke has the potential of making a large impact on stroke mortality and recovery.

Prevention of pneumonia after stroke

Current recommendations for prevention of pneumonia after stroke relate to processes of care and are based on evidence from observational studies.  Results of two small randomised controlled studies show that pharmacological interventions (metoclopramide, selective oral decontamination) are safe, and effectively reduce the incidence of pneumonia in dysphagic patients.  This needs to be confirmed in a larger study with longer-term functional outcomes.  This is what the MAPS-2 trial aims to achieve.