Prognosis and methods of treatment of pneumonia after stroke. What is the prognosis for pneumonia in bedridden patients after a stroke? Symptoms of pneumonia after a stroke

Pneumonia after stroke is a common complication that is diagnosed in 50% of cases. In 10-15%, the consequences of pneumonia in the elderly are fatal.

Clinical picture

Factors contributing to the development of pneumonia after a stroke:

• age (over 65);
• excess weight;
• chronic diseases of the lungs and heart;
• prolonged weakness, hospitalization and mechanical ventilation (more than 7 days);
• the use of H2 blockers;
• oppression of consciousness.

The reasons for the development of the disease:

• breathing disorder;
• change in blood flow in the ICC.

Experts identify the following symptoms of the disease:

• defeat of GM;
• violation of the drainage functions of the lungs;
• cough.

Staphylococcus aureus is the causative agent of pneumonia.

Common causative agents of the disease are:

• Staphylococcus aureus;
• colibacillus;
• klebsiella;
• Pseudomonas aeruginosa.

What to do if the first signs of pneumonia appear after a stroke, it is recommended to ask your doctor. Treatment is prescribed taking into account the type of pneumonia:

• early;
• late.

The disease is diagnosed 2-3 days after hospitalization. The patient has impaired regulation of the central nervous system, edema appears in the lungs. The prognosis depends on the localization of the focus. Late pneumonia (2-6 weeks) develops against the background of hypostatic processes. It is difficult to diagnose. Complications of the disease can be fatal.

Signs of pneumonia are manifested in the form of high body temperature, pathology of cough, wheezing. How long an adult's temperature lasts depends on the severity of the course of pneumonia. The main clinical and laboratory indicators:

• fever;
• blood leukocytosis;
• purulent process in the trachea.

To identify focal changes, an x-ray examination of the lungs is performed. To make an accurate diagnosis, experts consider the 4 above-described signs.

Therapies

Treatment of pneumonia after a severe stroke is aimed at suppressing the infectious process, stopping cerebral edema, and fighting inflammation. After the diagnosis is made, antibacterial agents (from various groups) are used. After 5 days, the course of therapy is adjusted taking into account the reaction of the body, the identified type of pathogen, the sensitivity of the virus to chemotherapy.

In the video you can watch about the treatment of pneumonia at home and in the hospital.

The patient is prescribed mucolytics, diuretics, cardiotonics, expectorants. It is recommended to carry out physiotherapy, do breathing exercises. If the patient has urinary incontinence, bladder catheterization is performed. Prevention of inflammation of this system consists in strict adherence to the rules of personal hygiene, washing the bladder, and passing a bacteriological analysis of urine. In men, the catheter is fixed to the abdomen. The inflammatory process is treated with antibiotics.

If the blood vessels are clogged with blood clots, additional examination of the patient will be required. A similar phenomenon is observed as a result of prolonged immobility and an active phase of rheumatism. For prevention, experts recommend early passive and active movements.

In a severe course of the disease, integumentary tissues may die. If this process penetrates deeply, the wound becomes infected, the body becomes infected. Prevention of pressure ulcers consists in regular changes in body position (once every 2 hours). The skin is treated with warm camphor alcohol. If the work of the large intestine is disrupted during pneumonia, you will need to follow a diet. The diet includes fiber and dairy products. For constipation, take a laxative. You need to drink up to 2 liters of liquid per day.

The video provides information on the prevention of pneumonia in a patient with a stroke, basic exercises and movements in a bed patient:

For the prevention of pneumonia after a stroke, it is recommended:

• sanitation of the nasopharynx;
• physiotherapy;
• hygiene;
• compliance with the rules of antiseptics;
• the use of a tracheotomy tube.

Do not take antibacterial drugs to prevent pneumonia.

Select a heading Adenoids Angina Uncategorized Wet cough Wet cough In children Sinusitis Cough Cough in children Laryngitis ENT Diseases Traditional methods of treating Sinusitis Folk remedies for cough Folk remedies for rhinitis Runny nose Runny nose in pregnant Runny nose in adults Runny nose in children Otitis treatment Cough drugs Sinusitis Treatments for cough Treatments for the common cold Symptoms of sinusitis Cough syrups Dry cough Dry cough in children Temperature Tonsillitis Tracheitis Pharyngitis

• Runny nose
  • Runny nose in children
  • Folk remedies for the common cold
  • Runny nose in pregnant women
  • Runny nose in adults
  • Cold treatments
• Cough
  • Cough in children
    • Dry cough in children
    • Moist cough in children
  • Dry cough
  • Moist cough
• Drug overview
• Sinusitis
  • Traditional methods of treating sinusitis
  • Symptoms of sinusitis
  • Treatments from Sinusitis
• ENT Diseases
  • Pharyngitis
  • Tracheitis
  • Angina
  • Laryngitis
  • Tonsillitis

Stroke is a serious disease characterized by acute circulatory disorders in the structures of the brain. Such a violation occurs quite quickly, but the treatment and rehabilitation of patients takes a lot of time and effort, both for the patient himself and those caring for him. Stroke often results in permanent disability in patients. Unfortunately, the death rate from stroke is also high. After a stroke, the patient may be immobilized for a sufficiently long period of time, or his physical activity will be minimized.

What to do if a patient has a cough after a stroke. Let's try to understand the situation and find out what causes of cough after a stroke are the same as in a person who has not suffered this condition, and what reasons are associated exclusively with the disease.

It should be noted that patients after a stroke have a weakened immune system, therefore, respiratory tract infections find fertile soil in their bodies. Numerous pathogenic viruses, bacteria can cause inflammatory processes in various respiratory organs (nasal cavity, larynx, trachea, bronchi, lungs).

Such patients are also susceptible to various allergic reactions, and since most of them have to spend a lot of time in a confined space, the allergic cough of such patients can be caused by the specific microflora of the room, dust, animal hair and other aggressive agents.

Very often, a spontaneous cough in a patient who has had a stroke occurs as a result of a foreign body entering the respiratory tract. This is due to the fact that as a result of the disease, there may be a violation of the coordination of movements, as well as other functions of the body, and those elementary actions that were not difficult before the disease and were reflexive may be inhibited or completely absent.

Stroke in most cases occurs against the background of hypertension, then sometimes a cough after a stroke can occur as a side effect of taking pharmacological drugs that lower blood pressure, such as: Enalapril, Captopril, Ramipril and their analogues (the so-called ACE inhibitors). Cough from drugs of this pharmacological group often occurs in patients with disorders of the heart and blood vessels, which include patients after a stroke.

The condition of the patient who has not restored motor activity requires special attention. Such patients should be carefully cared for, which consists primarily in:

• in regular (at least twice a day) ventilation of the room;
• sanitation of the oral cavity on their own or with the help;
• creating at least minimal mobility of the patient. If the patient is not able to roll over on his own, he needs to help or turn him over;
• in chest massage to prevent pulmonary congestion;
• breathing exercises, including inflation of balloons.

All these measures will help to avoid or reduce the risk of pressure sores and congestive pneumonia.

Congestive pneumonia occurs in bedridden patients as a result of stagnation of blood in the small (pulmonary) circulation. When lying for a long time, the amplitude of oscillations of the chest during inhalation-exhalation is limited, which first leads to the absence of a full-fledged entrance, which means that it limits the supply of oxygen to the body, and then to the lack of a full-fledged outlet, which does not allow to completely remove the accumulated carbon dioxide from the lungs. dust particles, mucus, microorganisms. In such a situation, the prerequisites are created for stagnation of blood in the lungs and a violation of mucus excretion. Against this background, congestive pneumonia can develop quite quickly, especially in the elderly.

Symptoms and Signs

If a bed patient has a cough after a stroke, do not delay the examination, this is a very serious symptom. Be sure to consult a doctor and do not self-medicate. Any pneumonia requires medical treatment, and a stroke is a factor that aggravates the course of the disease.

A cough with congestive pneumonia is accompanied by symptoms such as:

• shortness of breath;
• wheezing;
• hard breathing;
• fever (often to subfebrile);
• weakness.

Diagnosis - congestive pneumonia

Early diagnosis is often difficult due to disorders caused by the stroke itself, such as shortness of breath and shortness of breath. The more time has passed from the onset of the primary illness to pneumonia, the easier it is to establish a diagnosis.

Ultrasound and X-ray will help to accurately establish the diagnosis and begin treatment on time. When establishing a diagnosis, it is advisable to conduct a general and biochemical blood test. An increased number of leukocytes, an accelerated erythrocyte sedimentation rate, and an increased amount of reactive inflammatory proteins will indicate the presence of an inflammatory process.

Microscopy of sputum and its bacteriological culture will help not only to identify bacteria-causative agents of the disease, but also to select antibiotics for effective and gentle treatment.

Treatment of congestive pneumonia

Treatment of congestive pneumonia is carried out with medication, taking into account the patient's condition. The main directions of treatment:

• fighting bacterial infection;
• control of ventilation of the lungs;
• improved blood supply to the lungs;
• reduction of puffiness.

For treatment, an extended range of pharmacological drugs is used, in addition to antibiotics, to combat bacterial infection, expectorant drugs are used to improve sputum discharge, diuretics, immunomodulators, cardiac glycosides.

Physiotherapeutic procedures give a good effect in the treatment of congestive pneumonia:

• oxygen therapy;
• chest and back massage;
• inhalation;

So oxygen therapy has a beneficial effect on gas exchange in the lungs, heart, and normalizes the electrical activity of the cerebral cortex.

• Massages stimulate blood flow and relieve inflammation and swelling.
• Inhalations are carried out using herbal infusions, essential oils.

Therapeutic gymnastics can be carried out only when the patient is in a satisfactory condition, but with its beginning it is not necessary to delay. Any permitted activity will benefit the stroke patient.

Folk remedies to help

From the folk remedies for the treatment of pneumonia, you can recommend drinking thyme decoctions. The infusion is prepared at the rate of: two teaspoons of dry herbs per 0.5 liters of boiling water. The broth is taken four times a day before meals, half a glass. For the treatment of cough, you can prepare an infusion of viburnum and honey. The medicine is taken more than three times a day. Drinking plenty of rosehip and raspberry infusions will also help cure congestive pneumonia.

The measures for the treatment of congestive pneumonia can also include the setting of mustard plasters and compresses, but only after consultation with the attending physician.

In conclusion, we note that patients who have suffered a stroke can also become infected with viral infections leading to laryngitis, tracheitis, bronchitis, sinusitis, in which cough also occurs.

For citation: Piradov M.A., Ryabinkina Yu.V., Gnedovskaya E.V. Pneumonia in patients with severe stroke // BC. 2008. No. 26. S. 1718

Pneumonia is the most common and dangerous infectious complication of severe stroke. It occurs in half of patients and is the main cause of death in 14% of cases.

The high incidence of pneumonia in severe forms of stroke is due to the profound depression of consciousness that appears almost from the first day, central disturbances in breathing, swallowing and hemodynamic changes in blood flow in the lungs. The overwhelming majority of patients with severe strokes in the intensive care unit (ICU) develop "hospital" or so-called nosocomial pneumonia. This term denotes pneumonia that developed 48 or more hours after the patient was admitted to the hospital with the exclusion of infectious diseases with lung damage, which could have been in the incubation period at the time of hospitalization.
Highly virulent flora with rapidly increasing resistance to traditional antibacterial drugs leads to the development of severe forms of pneumonia with high mortality rates. An additional factor is the need for long-term mechanical ventilation, while the incidence of pneumonia increases 6-20 times. The risk of ventilator-associated pneumonia, so-called ventilator-associated pneumonia (VAP), increases significantly with an increase in ventilator time. The occurrence of pneumonia in severe stroke increases the length of stay of patients in neurocritical care units by an average of 10 days.
Etiology and pathogenesis
The main cause of pneumonia in severe stroke is a bacterial infection, the causative agents of which are characterized by pronounced pneumotropicity. The main pathogens are Pseudomonas aeruginosa, Enterobacter, Klebsiella, Escherichia coli, Proteus. Staphylococcus aureus, streptococcus pneumoniae, and, less commonly, anaerobic flora are also not uncommon.
According to our data, up to 20% of pneumonias that develop in patients with severe stroke almost immediately after hospitalization (early pneumonia) are caused by gram-negative flora. Pneumonia that occurs after 3 days in the ICU - late pneumonia - in more than 50% of patients are also caused by gram-negative strains.
There are some differences in the pathogenesis of early and late pneumonia. In the development of early pneumonia, decisive importance is attached to violations of cortical-visceral regulation. The rapidity of the development of early pneumonia in stroke, its predominant occurrence in patients with localization of the focus in the area of ​​the higher vegetative centers or with secondary exposure to the hypothalamus and stem structures, the presence of signs of circulatory disorders in the lungs of patients in the form of plethora, hemorrhages and edema confirm the role of central disorders in the genesis of this complication. In the development of late pneumonia, the factor of hypostasis plays a decisive role.
With the development of VAP within less than 7 days from the start of mechanical ventilation, pneumonia is caused by pneumococci, Haemophilus influenzae, Staphylococcus aureus and anaerobic bacteria. With the development of VAP at a later date after the start of mechanical ventilation, drug-resistant strains of enterobacteria, Pseudomonas aeruginosa, Acinetobacner spp. and methicillin-resistant strains of Staphylococcus aureus (MRSA). Sudden outbreaks of Legionella pn pneumonia are primarily associated with infections in humidifiers, inhalers, tracheostomy tubes, tap water, and air conditioners. In patients on long-term antibiotics or glucocorticoids, pneumonia may be due to fungi (eg, Aspergillius spp.).
Risk factors for the development of pneumonia in severe stroke are: the level of consciousness on the Glasgow coma scale less than 9 points, dysphagia, tracheal intubation, mechanical ventilation for more than 7 days, prolonged hospitalization, age over 65 years, the presence of chronic pulmonary and heart diseases, the use of H2-histamine blockers receptors, smoking, obesity, hyperglycemia, unbalanced diet, uremia.
The main route of penetration of microorganisms into the respiratory tract in patients with severe stroke is the bronchogenic route. It is associated with microaspiration of the contents of the nasopharynx and stomach due to bulbar disorders, inhibition of the cough reflex and the reflex that provides a reflex spasm of the glottis.
Extensive brain damage (more than any other critical condition) is accompanied by damage to the mechanisms of nonspecific defense of the body, including local cellular and humoral immunity, which also facilitates the bronchogenic penetration of microorganisms into the respiratory parts of the lungs. The change in the composition of the normal microflora of the upper respiratory tract to a highly virulent microflora that is very often resistant to traditional antibiotics contributes to the rapid infection of the lungs.
Of great importance is the violation of the drainage function of the respiratory tract: a decrease in the rate of mucociliary transport, which develops from the first hours of a stroke, which is often accompanied by an increased production of tracheobronchial secretions. In addition, infection through ventilators and during the necessary invasive procedures (sanitation of the tracheobronchial tree, fibrobronchoscopy), infection of the tracheostomy wound (or wound infection of the tracheostomy) increases the risk of invasion of microorganisms. It should be remembered that in each specific case, the features of the pathogenesis and clinical course are determined by the properties of the pathogen, the initial state of the patient and various body systems involved in inflammation, and the body's response to infection.
Clinic and diagnostics
Clinical diagnosis of pneumonia in severe stroke is still a challenge and continues to be developed. Difficulties in establishing a diagnosis are associated with both overdiagnosis and underdiagnosis, and late diagnosis is one of the reasons for the development of complications and death.
In patients with severe stroke, the clinical signs of pneumonia are masked by the symptoms of the underlying disease. The diagnosis of early pneumonia is especially difficult, since its clinical manifestations are hidden behind the severity of cerebral and focal neurological symptoms. Diagnosis of late pneumonia against the background of an improving neurological condition of the patient is less difficult. Complicates the examination process and the severity of the underlying disease, as well as the need for prolonged use of mechanical ventilation.
The clinical picture of pneumonia consists of signs of local pulmonary inflammation, extrapulmonary manifestations of pneumonia, laboratory and radiological changes. Diagnosis of pneumonia is usually carried out on the basis of the following clinical and laboratory signs (Table 1). It should be remembered that in conditions of severe stroke, each of these criteria is nonspecific.
Diagnosis of pneumonia is made only if 4 of the listed criteria are met, and the presence of 3 of them makes the diagnosis of pneumonia probable.
Treatment
Comprehensive treatment of pneumonia should be aimed at suppressing infection, restoring pulmonary and general resistance, improving the drainage function of the bronchi, and eliminating complications of the disease.
Antibacterial drugs are the mainstay of pneumonia treatment. The choice of the most effective one depends on many factors, including:
... accurate identification of the pathogen
... determining its sensitivity to antibiotics
... early initiation of adequate antibiotic therapy
Nevertheless, even with a well-equipped microbiological laboratory, the etiology of pneumonia can be established only in 50-60% of cases. Moreover, to obtain the results of microbiological analysis, at least 24-48 hours are required, while antibiotic therapy should be prescribed immediately, as soon as pneumonia is diagnosed.
The diversity of the etiology of hospital pneumonia, the simultaneous detection of several pathogens in one patient and the lack of methods for express diagnostics of the sensitivity of microorganisms to antibacterial drugs complicates the planning of therapy. Under these conditions, it becomes necessary to apply empirical antibiotic therapy, which provides the study of drugs with the widest possible spectrum of activity. The choice of a drug is based on an analysis of a specific clinical and epidemiological situation in which a given patient developed pneumonia, and taking into account factors that increase the risk of infection with one or another pathogen.
For hospital pneumonia in severe forms of stroke, the highest weight of gram-negative microflora, staphylococcus and anaerobic bacteria. Therefore, as a starting therapy, the most often used are I-III generation cephalosporins (in combination with aminoglycosides) or fluoroquinolones.
The following combinations and monotherapy regimens can be effective:
... Combination of ceftazidime with "respiratory" fluoroquinolones
... The combination of "protected" antipseudomonal ureidopenicillins (ticarcillin / clavulanic acid, piperacillin / tazobactam) with amikacin
... Monotherapy with IV generation cephalosporin (cefepime)
... Monotherapy with carbapenems (imipenem, meropenem)
... Combination of ceftazidime or cefepime or meropenem or imopenem with second generation fluoroquinolones (ciprofloxacin) and modern macrolides
The course of the pneumonia resolution process is assessed using clinical or microbiological studies. Clinical indicators are: a decrease in the amount of purulent sputum, a decrease in leukocytosis, a decrease in body temperature, signs of resolution of the inflammatory process in the lungs according to X-ray or computed tomography data. It is believed that the chosen treatment regimen should not be changed during the first 72 hours of empiric therapy.
With a progressive increase in inflammatory infiltration, it is necessary to adjust antibiotic therapy. It is recommended, if possible, to identify the microorganism and prescribe targeted (etiotropic) antimicrobial therapy. The subsequent change in antibiotic therapy should be carried out based on the results of only a microbiological examination of sputum.
Taking into account the type of the causative agent of pneumonia, the alleged pathogenetic mechanism of the development of pneumonia and the time of its development from the onset of stroke, the recommendations given in Table 2 can be followed.
The average terms of antibiotic therapy in patients with pneumonia are presented in Table 3. In most cases, with an adequate choice of antibiotics, 7-10 days of its use are sufficient. With atypical pneumonia, staphylococcal infection, the duration of treatment increases. Treatment of pneumonia caused by gram-negative enterobacteria or Pseudomonas aeruginosa should be at least 21-42 days.
One of the most important conditions for the successful treatment of pneumonia is the improvement of the drainage function of the bronchi. For this purpose, expectorant, mucolytic and mucoregulatory agents are used, chest massage (percussion, vibration, vacuum), breathing exercises are used. Broncho-lytics are prescribed for severe pneumonia and in persons prone to bronchospastic syndrome. In the ICU, it is preferable to prescribe intravenous infusions of a 2.4% solution of aminophylline, less often inhalation forms of b2-adrenergic stimulants, M-cholinergic lithics.
In severe forms of pneumonia, infusion of native and / or fresh frozen plasma is performed. Currently, the issue of the need for immunocorrective and immunosubstitution therapy with immunoglobulins and hyperimmune plasma is being considered. Patients with severe forms of pneumonia are also treated with detoxification therapy, taking into account cerebral edema and concomitant heart disease and heart failure.
Prophylaxis
The prevention of pneumonia in severe stroke is based on three main approaches.
1. Elevated position of the upper half of the patient's body at an angle of 450, frequent debridement of the nasopharynx and chest physiotherapy. These simple methods reduce the flow of secretions from the upper respiratory tract into the trachea and bronchi, i.e. microaspiration.
2. Personal hygiene of personnel (elementary frequent hand washing with a disinfectant solution), careful adherence to the rules of asepsis and antiseptics, strict adherence to protocols for changing and cleaning tracheostomy tubes, humidifier and inhaler reservoirs reduces the growth rate and the addition of additional microflora.
3. The use of a certain type of tracheostomy tube (with supra-cuff aspiration) and its correct positioning, timely aspiration of secretions accumulating over the cuff, orotracheal intubation, introduction of a tube for enteral feeding through the oral cavity reduce the risk of infection of the lower respiratory tract with nasopharyngeal flora. In addition, it helps to reduce the risk of developing sinusitis.
Until now, the whole world has not formed a unified view of the prophylactic prescription of antibiotics. In our opinion, this approach definitely does not solve the problem of preventing pneumonia in stroke, especially VAP. It must be remembered that pneumonia is a process characterized by certain features of the course associated with the initial state of the patient and his response to infection, and the role of antibiotics is limited only to suppression of the infectious agent. In addition, with the prophylactic administration of antibiotics, the development of superinfection caused by antibiotic-resistant strains of microorganisms is possible.
Conclusion
Our data and analysis of the literature indicate that the occurrence of pneumonia in patients with severe stroke worsens the condition of patients. In patients who have experienced a period of neurological complications, pneumonia is often fatal. Preventive measures should be started already from the first hours of a stroke, and rational therapy for pneumonia should be started immediately after its diagnosis.

Literature
1. Vilensky B.S. Somatic complications of stroke // Neurological journal. - No. 3. - 2003. - p. 4-10.
2. Koltover A.N., Lyudkovskaya I.G., Vavilova T.I., Viktorova N.D., Gulevskaya T.S., Levina G.Ya., Lozhnikova S.M., Morgunov V.A., Tchaikovskaya R.P. The role of pathology of internal organs in the pathogenesis, course and outcome of strokes. // Materials of the plenum of the board of the society of neuropathologists and psychiatrists "Disorders of the nervous system and mental activity in somatic diseases." - Naberezhnye Chelny. - 1979. - S. 198-201.
3. Krylov V.V., Tsarenko S.V., Petrikov S.S. Diagnostics, prevention and treatment of hospital-acquired pneumonia in critically ill patients with intracranial hemorrhage. // Neurosurgery. - 2003. - No. 4. - S. 45-48.
4. Martynov Yu.S., Kevdina O.N., Shuvakhina N.A., Sokolov E.L., Medvedeva M.S., Borisova N.F. Stroke pneumonia. // Neurological journal. - 1998. - No. 3. - S. 18-21.
5. Addington W.R., Stephens R.E., Gilliland K.A. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. // Stroke. - 1999. - 30. - 6. - P.1203-1207.
6. Chastre J. and J.-Y. Fagon Ventilator-associated pneumonia. //Am. J. Respir. Crit. Care Med. April 1. 2002. 165 (7). - R.867 - 903.
7. Collard H. R., S. Saint, and M. A. Matthay Prevention of Ventilator-Associated Pneumonia: An Evidence-Based Systematic Review Ann Intern Med. // March 18. - 2003. - 138 (6). - R.494 - 501.

A bed patient is a great challenge for his entire family. It must be passed, giving your elderly relative a chance to live longer. For this, it is necessary not only to ensure his physiological needs, but also to pay attention to the slightest changes in his condition. Because under any of them, even if it is a "trifle" like constant drowsiness, congestive pneumonia can be hidden - a disease that takes the lives of bedridden patients.

Congestive (hypostatic) pneumonia is an inflammation of the lung tissue, which develops initially in areas where blood and tissue fluid accumulates and cannot circulate normally. These areas become "easy prey" for infection, which of them is able to spread to the rest of the lungs. Bedridden patients suffer from congestive pneumonia most often. The risk of getting it increases in old age, with heart disease and undergoing surgery. Masquerading as symptoms of an underlying disease, hypostatic pneumonia can be late recognized, often resulting in death. Only close cooperation of a competent doctor and caring relatives give chances for the timely start of treatment of pathology.

How the lungs work

In order for oxygen to enter the vessels, it must go a rather long way from the nose to the smallest bronchi, and ultimately get into the alveoli - the main structures in which gas exchange takes place. In their structure, the alveoli are similar to "sacs", open from the side where air enters them. The walls of the alveoli are a membrane. On the inside, it fills with air, and on the outside, it borders on a blood vessel. Oxygen passes through the membrane into the blood, and carbon dioxide enters the “bag” from the blood, which should be released on exhalation. If the wall of the alveoli becomes denser or fluid appears between it and the vessel, gas exchange deteriorates.

But even normally, different parts of the lungs are ventilated, that is, they are supplied with air, unevenly. In an upright position, air is best supplied to the lower parts of the lungs, where the elastic lung tissue is well stretched by the diaphragm, and this is facilitated by movable ribs. If a person lies on their back, intra-abdominal pressure rises. But this not only reduces ventilation in the lower parts of the lungs, but also leads to a decrease in inhaled volumes.

If a person is sick with emphysema, pneumofibrosis or bronchial asthma, then, even when he is not lying down, breathing in different parts of the lungs becomes more uneven, and this creates conditions for the habitation of microbes in poorly ventilated parts.

But in order for the body to receive a sufficient amount of oxygen, the intake of air into the lungs is not enough. You also need to have enough blood supply to your lungs.

Blood to the lungs comes from the pulmonary artery. The way from the heart to the smallest pulmonary capillaries, blood does not under pressure and not because of its pushing by the heart muscle - only along the pressure gradient: it flows from the highest pressure to the lowest. Therefore, blood flow is highly dependent on body position: in a standing position, the lower parts of the lungs are best supplied with blood, and when lying on the back, more blood accumulates in the areas closer to the back.

At rest, in a healthy person, blood flows only through half of the pulmonary capillaries. During physical work, the pressure in the pulmonary arteries increases, and more vessels begin to turn on in the work. The alveoli, which communicate with them, must gain access to air - then breathing can provide a person's oxygen needs.

When a person is constantly lying, especially if he does not change his position in bed, it is difficult for blood to "get" from the lungs to the heart against gravity. Blood stagnation occurs, which leads to the expansion of local capillaries. The dilated and full of blood vessels become heavy and squeeze the alveoli. This is the onset of congestive pneumonia. If the situation does not change, the liquid part of the blood flows from the capillary into the alveoli and the tissue that lies between the alveoli. An infection quickly gets here, which can also spread to neighboring parts of the lungs. If the situation is not changed, or only the destruction of the infection is carried out, the affected lung tissue is replaced by connective tissue, and is permanently switched off from breathing.

Causes of congestive pneumonia

As can be seen from the previous section, congestive pneumonia in bedridden patients develops due to their immobile position, which causes stagnation in the pulmonary circulation. The disease can develop early (2-4 days) after a forced horizontal position, but its appearance may be delayed (14 days or later).

The risk of developing congestive pneumonia in the early stages is higher in older people who suffer from:

• angina pectoris;
• cardiosclerosis;
• heart defects (especially if it is mitral valve stenosis);
• heart rhythm disorders: extrasystole, atrial fibrillation;
• arterial hypertension arising from various reasons;
• lung diseases: bronchial asthma, bronchiectasis, emphysema;
• diabetes mellitus;
• chronic pyelonephritis;
• diseases of the bone skeleton: kyphosis, scoliosis in the thoracic region, deformities of the ribs,

as well as those people who have recently undergone any operation, which is explained by the fact that the postoperative wound hurts, so the person tries to breathe more shallowly, thereby increasing congestion in the lungs. For these categories of persons, it is important to start the prevention of congestive pneumonia as early as possible, as well as call a doctor at each change in the state and exclude the development of this particular disease in the first place.

In addition to the poor outflow of blood from the pulmonary vessels, an infection is needed for the occurrence of congestive pneumonia.

The microbes that cause inflammation of the fluid released from the pulmonary capillaries usually become:

• streptococci, in particular pneumococcus;
• haemophilus influenzae;
• staphylococci.

The favorite localization of congestive inflammation is the lower sections of the right lung, but with a combination of immobility and one of the above diseases, pathology can become bilateral.

Why is congestive pneumonia dangerous?

The danger of the disease lies in the fact that those parts of the lungs where there was a sweating of fluid into the alveoli and the tissue between them cease to participate in breathing. In addition, when a person, against the background of the development of this pathology, continues to lie, it becomes difficult for him to cough up sputum (and a cough reflex does not always occur). As a result, it clogs the bronchi, and an even larger area of ​​the lung ceases to participate in breathing.

The addition of an infection leads to the poisoning of the body of an elderly person with the products of the vital activity of microbes. This is toxic to the heart, exacerbating its damage. In addition, intoxication leads to a decrease in appetite, and as a result, a person refuses to receive the proteins and vitamins necessary to fight infection and restore lung tissue.

Other dangers of congestive pneumonia in bedridden people are complications such as exudative pleurisy (effusion of inflammatory fluid outside the lungs, into the pleural cavity) and pericardial effusion (effusion of inflammatory fluid into the bursa). As a result of the first complication, respiratory failure is further aggravated. Exudative pericarditis, as a result of squeezing the heart with fluid, leads to a deterioration in the work of its muscles.

Symptoms

Congestive pneumonia is a very insidious disease for a bedridden patient. Arising against the background of the pathology that confined a person to bed, it is disguised as his symptoms. So, a person who has suffered a stroke develops a slightly greater inadequacy or lethargy than it was before, or a person with a hip fracture on the background of osteoporosis began to complain of chest pain. Such symptoms are not always noticeable to relatives, who spend most of the day at work, and are not recognized by the patient himself.

More obvious signs of congestive pneumonia, which, unfortunately, sometimes appear already in the later stages of the disease, are:

• increase in body temperature: it can be small, up to 38 ° C, but in some cases (less often) it can exceed 38.5 ° C;
• moist cough. If a person is able to cough up, and not swallow phlegm, then it is clear that it has a mucopurulent character, streaks of blood may come across;
• weakness;
• nausea;
• lack of appetite;
• sweating

Congestive pneumonia is accompanied by symptoms of the cardiovascular system: heart rhythm disturbance, heart rate increase, the appearance of interruptions or pain in the heart. The disease can also manifest itself not by coughing or fever, but by nausea and diarrhea.

The fact that a significant part of the lungs has ceased to participate in breathing is evidenced by the increase in breathing rate of more than 20 breaths per minute at rest (not when a person eats or makes any efforts), a feeling of lack of air. If pneumonia is extremely difficult, the person's consciousness is depressed: he becomes extremely sleepy, he may stop waking up, not answering questions, tossing and turning in bed and saying incoherent phrases. In this state, breathing becomes either extremely rare, or arrhythmic, or very frequent. These symptoms indicate that urgent hospitalization is needed, but the prognosis, unfortunately, can be unfavorable here.

Diagnostics

A general practitioner who hears wheezing or crepitus in the lungs (especially in the lower parts) can suspect congestive pneumonia. But the diagnosis is made only on the basis of radiography. It is performed in multidisciplinary clinics or polyclinics at the place of residence, where there is an Arman apparatus or a stationary X-ray machine adapted for bedridden patients.

The patient can be delivered to the X-ray using any of the paid medical services (or paid ambulances), equipped for the transportation of bedridden patients. Although the best option is hospitalization in a hospital, where an X-ray will be performed, and doctors and qualified personnel will monitor your relative's condition.

In order to select the necessary antibacterial drugs, the patient must pass sputum tests. Both analyzes are collected in sterile jars: the first is sent to the clinical laboratory, the second to the bacteriological laboratory. With the help of clinical analysis, the nature of the inflammation is determined, cancer or tuberculosis cells are found. Bacteriological analysis of sputum makes it possible to establish the type of microbe that caused pneumonia, as well as to select antibiotics that will act specifically on it.

The survey also includes:

• general blood and urine tests;
• determination of blood gases;
• biochemical blood test;
• Ultrasound of the heart.

Treatment of congestive pneumonia

The disease requires complex therapy, since during its development the activity of many internal organs is disrupted.

First and foremost, doctors must determine if oxygen balance is affected. If this happens, the patient is admitted to the hospital where there is an intensive care unit, and treatment is started:

• if the balance is not greatly disturbed, breathing with humidified oxygen is prescribed using a mask;
• if severe respiratory failure has developed, the patient is injected into anesthesia, against the background of which he is transferred to artificial ventilation. This is the only way to supply oxygen to the alveoli at the right pressure.

The second direction of therapy is the appointment of antibacterial drugs. First, before the results of bacteriological research (bacteriological culture) of sputum and blood are obtained, a wide spectrum of drugs are prescribed. After 5 days, if necessary, change antibiotics, apply those to which the sputum microflora was sensitive. The optimal route of administration of these drugs, at least the first 5-7 days, is intramuscular or intravenous.

In parallel with taking antibiotics, even before the results of bacterial seeding, antifungal agents are prescribed. This is due to the fact that, according to statistics, most stagnant pneumonia is caused not by bacteria alone, but by a combination of bacteria and fungi.

The next mandatory component of therapy is the appointment of drugs that expand the bronchi: this can facilitate the drainage of sputum and improve the airway for oxygen. Bronchodilator drugs can be administered by inhalation if the person is not on mechanical ventilation. The intravenous route of their administration is also used.

Also, with congestive pneumonia, drugs are prescribed that improve the flow of oxygen into the blood, as well as facilitate the work of the heart. These are diuretics, expectorant, antioxidant and immunomodulatory agents, cardiac glycosides.

If the bedridden patient is conscious, he is asked to cough up phlegm. If he is on artificial lung ventilation, or his cough reflex is inhibited, he is given bronchoscopy every day - cleaning of large and medium bronchi using a special device equipped with optics (that is, the doctor sees what condition the bronchi are in) and a system for vacuum removal of bronchial discharge ...

With congestive pneumonia, the lying person must necessarily perform vibration massage, turns from side to side, and also, after stabilization of the condition, spreading on the stomach (in this position, phlegm is better off).

If complications such as exudative pleurisy or pericarditis develop, a puncture of the pleura or pericardium is performed in a hospital setting, followed by removal of stagnant fluid.

When the patient is conscious and does not need to be transferred to artificial ventilation, breathing exercises are necessarily assigned to him. These are classes on the Strelnikova and Buteyko complexes, inflating balloons, blowing out candles, exhaling through a tube into the water.

During treatment, it is imperative to provide the patient with a complete diet rich in vitamins and proteins. If the patient is conscious, and his swallowing and chewing reflexes are preserved, it is recommended to eat grated meat products, steamed or boiled. If the patient cannot swallow or is on apparatus breathing, he is fed through a tube - a tube inserted through the nose into the stomach, and enpits, second broths, vegetable decoctions with streaks of meat are used for nutrition. As a drink, such patients are given fruit drinks, a weak rosehip decoction, thyme decoction, linden tea.

When the patient's condition is stabilized, in addition to active turns in bed, he will need vibration massage of the chest, back massage, physiotherapy.

Prophylaxis

To maximize the safety of a lying relative from congestive pneumonia, follow these simple rules:

1. Be sure to help him change his body position every 2 hours. Don't forget to lay it on your stomach.
2. Having laid out an elderly bedridden patient on his stomach 3 times a day, take "Camphor alcohol" and rub the area of ​​the lungs, bypassing the area of ​​the spine.
3. In the prone position, perform a vibration massage of the lungs. To do this, place the palm of one of your hands on the chest of a relative, from the back, and lightly tap on it with the fist of the other hand. The direction of these movements is from the lower sections to the upper ones.
4. Once every 3-4 days, put mustard plasters on the patient's back or perform a cupping massage.
5. Breathing exercises should be performed daily: according to Buteyko, according to Strelnikova, or prescribed according to the experience of the attending physician.
6. The bedridden patient should not be hypothermic, so he should be sufficiently warmly dressed.
7. He also cannot overheat.
8. The room in which the patient is located should be ventilated (while he should not be in a draft) and quartz 2 times a day. Daily wet cleaning is a must.
9. The bedridden patient should have adequate nutrition, rich in proteins, trace elements and vitamins.
10. A lying relative must be periodically examined by a doctor.
11. Every day you need to measure the temperature and monitor the patient's condition: its adequacy, drowsiness, pulse, pressure and number of breaths per minute. When the condition changes, a doctor's consultation is needed.

The onset of pneumonia after an attack is characterized by a significant deterioration in the patient's condition. Inflammation of the lungs is an often fatal complication. Therefore, prevention of complications is a very important part.

Reasons for the development of pneumonia after a stroke

After a severe stroke, pneumonia of the bacterial form most often develops, the causative agents of which are E. coli and Pseudomonas aeruginosa, enterobacteria, Staphylococcus aureus, Klebsiella. This is due to the presence of a stroke in stationary conditions.

There are a number of factors that lead to pneumonia:

• age category ;
• overweight and obesity;
• depressed consciousness in severe cerebral stroke;
• artificial ventilation of the lungs for a long time;
• immobilized state;
• the effect of some drugs - antacids, H-2 blockers;
• the presence of chronic pathologies of the heart and pulmonary system.

Why does pneumonia occur and how are the heart and lungs interconnected? It turns out that breathing is controlled by the respiratory center located in the brain stem, which contains many chemoreceptors. It is they who carry out reactions to any changes in the gas composition of the blood fluid.

When the level of carbon dioxide in the blood rises, the respiratory center directs its impulses to the lungs. Those, in turn, contract, raising the rib bones, which causes the chest cavity to increase in volume. This is how the inhalation of air by a person occurs. At this stage, tissues and cells are saturated with oxygen, and chemoreceptors at this moment relax the muscles, after which exhalation occurs. Based on this, it can be argued that cerebral stroke is closely related to the respiratory system.

• The aspiration type of pneumonia occurs against the background of the penetration of food debris into the respiratory tract, due to which the segments of the lung tissue are damaged and cease to function. Together with food, pathogenic microorganisms also get here, which begin to multiply actively, provoking an inflammatory process. The patient coughs, symptoms of poisoning appear. If food enters the bronchi, they overlap.
• A congestive or hypostatic type of pneumonia develops mainly in seriously ill people. Due to a prolonged static posture in a horizontal position, the pulmonary circulation is disturbed in the pulmonary system. Accordingly, natural ventilation is also disturbed, sputum cannot leave, against the background of which pathogenic bacteria spread through the lungs. Most often, this form is converted into purulent.

And in one, and in another case, the patient is connected to mechanical ventilation (artificial ventilation) for the entire period of drug treatment.

The danger of pneumonia after a stroke, possible complications

With congestive pneumonia, it is not always possible to recognize the disease in the early stages. This is due to the fact that the symptoms are largely similar to the signs of the consequences of a stroke.

If you do not take measures and do not carry out adequate treatment, the following complications arise:

• Loss of respiratory function in part or in whole. This is fraught with the fact that artificial ventilation is connected, but it does not supply the body with an amount of oxygen sufficient for normal blood supply.
• If pneumonia is not treated, intoxication of the body is possible, which leads to a violation of the functionality of the heart muscle. Against this background, various heart diseases develop - and so on.
• Sudden death, especially if it is a hypostatic type of disease.

Symptoms

Pneumonia after a stroke is characterized by the following symptoms:

• high body temperature up to 39 degrees;
• severe shortness of breath and cough;
• difficulty breathing, particularly when inhaling;
• breathing can be of the Kussmaul or Cheyne-Stokes type;
• cough feature: initially - painfully dry, after - with phlegm;
• sputum has bloody clots;
• signs of intoxication: headache, nausea and vomiting, chills, muscle weakness, impaired consciousness, lack of appetite.

Treatment features

Before determining the tactics of therapy, a comprehensive examination is carried out. Blood tests are taken to the laboratory to assess the level of leukocytes and the degree of erythrocyte sedimentation. Be sure to do a chest x-ray, bronchoscopy, computed tomography. It is important to donate bacterial culture of sputum and blood for biochemical analysis.

Treatment is aimed at stopping hypoxia, suppressing a pathogenic microorganism, restoring the drainage capacity of the bronchi. It is important to prevent the development of complications and normalize the level of the immune system. The functionality of the pulmonary system must be resumed.

The following can be assigned:

• Etiotropic treatment involves antibiotic therapy. Broad-acting drugs are used. If pneumonia is at an early stage of development, the patient takes Ceftriaxone or Ampicillin. In the later stages - Tobramycin, Ciprofloxacin, Meropenem, Piperacillin. When stagnant - Metronidazole or Clindamycin. To speed up obtaining a positive result, a combination of some antibiotics is recommended. The duration of the course of treatment is from 10 days to one and a half months.
• To maintain the respiratory capacity of the pulmonary system, oxygen therapy is used, that is, the patient is connected to mechanical ventilation. This makes it possible to avoid oxygen starvation, restore the gas composition of the blood fluid and acid-base balance.
• To improve drainage ability, drugs with bronchodilator, bronchodilator and mucolytic properties are prescribed. It can be Euphyllin, Acetylcysteine, Bromhexine. Such therapy is allowed only with spontaneous breathing. If the patient is connected to artificial ventilation, then the sputum fluid is artificially aspirated.
• It is important to use immunomodulators - Dekaris, Timalin.
• Diuretics are included in therapy, due to which excess fluid is released from the body and blood pressure decreases.
• In some cases, hyperimmune plasma is administered and immunoglobulins are prescribed.
• To accelerate the expectorant properties, the patient is sent to physiotherapy procedures. It can be manual or vibration massage, oxygen therapy, breathing exercises. When using physiotherapy devices, bronchodilators are used.

After about 5 days, the attending physician conducts diagnostics to assess the positive dynamics. In this case, blood leukocytosis should decrease, sputum should leave, and body temperature should decrease.

The duration of therapy, dosage and drugs are selected at the individual level. It depends on the type of pathogen, the characteristics of a particular organism, the course of the disease, the presence of other pathologies and other factors.

Forecast

Post-stroke pneumonia can be early or late. The first develops over the course of a week against the background of damage to the respiratory center of the brain and respiratory failure. The late stage appears due to stagnation in the circulatory system, which can be restored in a short time. Therefore, the forecast is more favorable.

If therapy begins in a timely manner, and the doctor selects the correct and accurate tactics, the outcome will be quite favorable.

On the other hand, the age category plays a huge role - the older the patient is, the more likely it is to develop serious complications. The prognosis is also influenced by factors such as the degree of brain damage in a stroke. In general, in 15 cases out of 100 with complicated pneumonia after a stroke, a fatal outcome occurs.

Prophylaxis

It is difficult to cure pneumonia after a stroke, therefore, preventive measures begin immediately after the patient is hospitalized. Prevention includes the following actions:

• to reduce the pathogenic factor (infection), the medical staff provides the patient with proper conditions - disinfection of instruments and premises;
• if the patient is connected to a ventilator, the trachestomy (breathing tube) must be treated with antiseptics and solutions;
• it is important to often change the position of the patient's body in order to prevent significant congestion, the head should always be at the top (on a high pillow);
• you need to sanitize the oral cavity, nasopharynx;
• it is important to carry out physiotherapy procedures for the upper respiratory tract;
• you cannot do without vacuum, percussion or cupping massage in the chest area;
• the patient himself must engage in physical exercise, even lying down, developing the shoulder girdle;
• do breathing exercises.

How massage is done to prevent the development of pneumonia after a stroke attack - see our video:

If a person has suffered a stroke, then the risk of pneumonia remains even after discharge from the hospital, therefore, at home, relatives are required to monitor the patient's condition and adhere to preventive measures. The attending doctor will give the necessary recommendations.