In a trial of the safety and tolerability of NXY-059 (CHANT [Cerebral Hematoma and NXY Treatment]) in patients with sponta- neous ICH, at least 1 adverse event was reported in 88% of the placebo-treated patients, 40% of which were serious (ie, resulted in prolonged hospitalization, were immediately life threatening, or were fatal). The most common compli- cations were pneumonia (5.6%), aspiration (2.6%), respira- tory failure/distress (2%), PE (1.3%), and sepsis (1.7%).171 Approximately 50% of deaths after stroke are attributed to medical complications, usually after 7 days of hospitaliza- tion. Stroke patients who experience medical complications while in the hospital have increased mortality up to 4 years after the initial event. Dysphagia and aspiration are major risk factors for the development of pneumonia. Dysphagia is defined by swal- lowing impairment of the upper digestive tract and includes impairments in swallowing efficiency and safety, with delays in the timing of movements, reduced range of movements, and frank aspiration. Aspiration in this population is a sign of severe dysphagia and refers to abnormal entry of fluid, particulate exogenous substances, or endogenous secretions into the airways. In a retrospective study that included 90 Japanese ICH patients, 68% could not tolerate oral feed- In another German study of 208 ICH patients, 25% of patients required percutaneous endoscopic gastrostomy.173 In this study, GCS, occlusive hydrocephalus, mechanical venti- lation, and sepsis were independent risk factors for dyspha- gia and percutaneous endoscopic gastrostomy placement. In a prospective multicenter study, use of a formal screen- ing protocol for dysphagia (eg, water swallow test) for all patients admitted with ischemic stroke was associated with a significantly reduced risk of pneumonia compared with no The pneu- monia rate of sites with a formal dysphagia screen was 2.4% versus 5.4% of those without a screen, a 3% absolute risk reduction. 