Pulmonary edema after stroke. Pulmonary edema due to inflammation after a stroke

In almost 15% of them, pneumonia ends in death.

Reasons for the development of complications

The high frequency of post-stroke pneumonia is directly related to the fact that severe forms of cerebrovascular accident in patients lead to a deep depression of consciousness and respiration, swallowing and coughing reflex. The situation is also aggravated by hemodynamic changes in the blood circulation of the lung tissues, weakened immunity, failure in the drainage system of the bronchi. All this contributes to an imbalance in the work of normal microflora and its displacement by pathogenic ones.

The vast majority of patients, entering the intensive care unit or intensive care unit, receive the so-called nosocomial pneumonia, which develops in the first two days from the onset of an acute period of cerebrovascular accident.

The factors that provoke this dangerous complication include:

Age 60 and over.
Overweight.
Patient's stay for more than a week artificial ventilation lungs.
Prolonged static position, adynamia.
Chronic cardiovascular and pulmonary pathology in history, uremia and hyperglycemia.

The risk group for the development of complications also includes patients with reduced level immune protection and with acute and chronic diseases of the nasopharynx and oral cavity.

The mechanism of development of complications

Early pneumonia after a stroke can occur in cases of bacterial infection due to insufficient disinfection of equipment, invasive procedures (sanation, fiberoptic bronchoscopy), or lack of proper care. In bedridden patients after a stroke, particles of food or vomit enter the upper respiratory tract. Disturbed swallowing and the absence of a cough reflex give impetus to the development of aspiration pneumonia.

But the main cause of the complication is the stagnation of fluid in the lungs due to the shutdown of the diaphragm. A favorable environment is created for the development of pathogenic flora and, as a result, pneumonia with pulmonary edema in stroke.

At a later date (from 2 to 6 weeks), inflammation is provoked by hypostatic processes: the patient lies on his back for a long time, there is no productive cough, and sputum does not go away.

Each case of congestive pneumonia has its own characteristics and clinical course, which depend on the type of pathogen (gram-negative flora, staphylococcus, fungal infection, Pseudomonas aeruginosa, anaerobes), the initial state of the patient. The localization of the focus in the brain also affects the rate of development of the complication.

Clinical manifestations

Diagnosing early pneumonia after a stroke is quite difficult.

Its symptoms are nonspecific, similar in signs to the primary pathology:

moderate fever.
Violation of the respiratory rhythm.
No cough reflex.

The main clinical and laboratory indicators of the development of pneumonia are:

Increased white blood cell count.
Purulent discharge from the trachea.
Pathological changes on x-rays.
Wheezing, gurgling or bubbling sounds during breathing.

Late pneumonia in stroke occurs with more severe symptoms:

Fever up to 39–40 °C.
Frequent bouts of chills.
Isolation of purulent sputum.
Wet wheezing.

On the radiograph, the transparency of the lung field is reduced with delicate cloud-like infiltrates of small diameter (up to 3 cm).

If a specialist diagnoses inflammation at the initial stage, timely therapy starts gives a positive prognosis.

If a complication is suspected, tomography, a plain chest x-ray are prescribed. To identify pathogenic microflora in a patient, sputum is taken.

Treatment program

Drug therapy should solve several important problems:

Maximum in short time stop hypoxia.
To prevent the development of pulmonary edema in stroke.
Suppress and neutralize the causative agent of infection.
Restore the drainage capacity of the bronchi.
Resume normal lung function.
Boost immune defense.

Medical therapy with antibiotics a wide range actions are assigned immediately after confirmation of the diagnosis and lasts from 10 to 40 days. The program includes antibiotics of the I-III generation cephalosporin group, which are combined with aminoglycosides and fluoroquinolones in the following combinations:

Ceftazidime and respiratory fluoroquinolone.
Amikacin and one of the antipseudomonal penicillins.
Monotherapy with IV generation cephalosporin (Cefepime).
Ceftazidime and Cefipime, Imopenem and a second-generation fluoroquinolone.

The treatment includes:

Diuretics.
Cardiotonics.
Mucolytics.
Drugs that stimulate the cough center.
Immunomodulators.
Detoxification agents
Native or fresh frozen plasma.

As auxiliary procedures to improve expectoration, the following is prescribed:

Oxygen therapy.
Course of manual or vibration massage.
Breathing exercises.
Physiotherapy with bronchodilators.

The effectiveness of the treatment is checked approximately on the fifth day. Indicators of positive dynamics and stop inflammatory process:

Reduced to normal values temperature.
Reducing the amount of allocated purulent sputum.
Decreased leukocytosis in the blood.

Adequate and timely therapy gives a favorable prognosis for a cure. But in older patients, the chances of recovery are reduced: every tenth case of acute cerebrovascular accident, accompanied by pneumonia, ends in death.

Prevention

Inflammation of the lungs can be avoided if the patient is provided with proper care with a number of important procedures.

For the diaphragm to work and eliminate stagnation, you need:

Regular turning of the patient from the right side to the left side 6-8 times a day, sitting on the bed, laying on the stomach.
Thorough cleaning of the oral cavity: teeth, tongue, gums from food debris.
Daily massage (3 to 5 times) of the upper third of the chest
Physiotherapy.
balloon inflation, plastic bags blowing air through a tube inserted into a container of water.
At home, alternation of cans and mustard plasters is recommended.

The patient should lie on a special functional bed with the head end raised by 30–60°. The room should be regularly ventilated and equipped with an air humidifier.

Medical and service personnel must strictly observe the rules of hygiene, all equipment and care products are carefully treated with disinfectant solutions.

The patient weakened by the disease should be protected from any contact with the infection.

Untreated pneumonia after a stroke is always fatal. When not timely treatment the disease may be complicated by an abscess, gangrene, exudative pleurisy or empyema.

Causes of pneumonia after a stroke and prevention

Pneumonia after a stroke is a fairly common and unpleasant complication that occurs in 50% of cases of cerebrovascular accident. It is pneumonia that becomes one of the main causes of death in patients who have suffered a brain stroke. In order to prevent the development of this complication, as well as to quickly restore the normal functioning of the body, it is necessary to know the causes of pneumonia, as well as its symptoms, which allow timely detection of the development of the disease.

What are the causes of the disease

There are many risk factors that contribute to the development of inflammation in the lung cavity after the transfer of impaired blood circulation in the brain.

These factors include:

the onset of a stroke over the age of 65;
increased weight;
cardiac pathologies in a chronic form;
oppression of consciousness;
holding the patient artificial ventilation of the lungs, which lasts more than 7 days;
prolonged stay in a lying, immobilized position;
treatment with H2 blockers.

The following causes influence the appearance of pneumonia after a stroke:

The causative agents of this disease are most often:

klebsiella;
intestinal and Pseudomonas aeruginosa;
golden staphylococcus.

Doctors distinguish 2 types of pneumonia, which differ in the causes of their occurrence and characteristic symptoms:

aspiration pneumonia. This condition occurs as a result of the entry of small food components into the upper respiratory tract, which leads to the cessation of the affected part of the lung tissue. Microorganisms in them cause inflammation. The main symptoms of this type of pneumonia resemble intoxication, which is characterized by strong cough. Worst of all, when pieces of food that have entered the respiratory system block the area of \u200b\u200blarge bronchi. As a result, it is very difficult for the patient to cough, and after a few days pneumonia occurs with high fever.
congestive pneumonia. This type of disease is mainly diagnosed in bedridden patients, since the constant presence in this position causes serious circulatory disorders in the lungs. As a result of this, ventilation of the lungs is aggravated, and sputum is difficult to expel.

The prognosis of pneumonia directly depends on the cause that caused the development of the disease.

Symptoms and diagnosis of the disease

When an early or first form of pneumonia appears, which develops within 72 hours after the onset of a stroke, it is quite difficult to notice the symptoms of this complication. This can be explained by the severe condition of the patient after a violation of blood circulation in the brain, which causes a blurred clinical picture.

However, there are still several symptoms of an early form of pneumonia:

slight increase in body temperature;
changes in the lung tissues that are clearly visible on the x-ray;
wheezing, bubbling and gurgling sounds when breathing;
an increase in the number of leukocytes in the blood;
mild cough, which is often absent in the victim.

Late and running form pneumonia develops within 2-6 weeks after the onset of a stroke and if left untreated this complication can be fatal.

The main symptoms of this stage:

chills and fever 38-39.5 degrees;
purulent sputum;
coughing may occur;
a significant increase in the level of leukocytes in the blood.

If pneumonia is suspected, the doctor prescribes sputum tests to the patient, which will determine the presence of the pathogen. In addition, the patient is recommended to examine the chest, which is carried out using an x-ray.

If it is possible to establish the presence of pneumonia in a timely manner even at the initial stage of its development, then the treatment started on time allows one to hope for positive results.

The risk of pneumonia after a stroke

It is worth knowing that catching pneumonia in the hospital is quite easy. For this, it is enough that the human body is struck by staphylococcus aureus, and a stroke develops.

Avoiding the onset of pneumonia in this case is not easy, because as a result of this disease, circulatory disorders occur.

With absence effective treatment The patient may develop the following unpleasant consequences:

Intoxication - an incompletely cured disease leads to gradual and dangerous poisoning, which immediately affects the work of the heart muscle.
Loss respiratory function- in order to cope with the situation, the patient needs to install a device for ventilating the lungs, which makes it difficult to rehabilitate the patient, because in order to restore health, it is necessary to ensure a normal supply of oxygen.
Fatal outcome - lack of treatment or ineffective therapy for pneumonia often leads to the death of the patient.

In order to prevent the development of complications, the patient receives medication. In addition, the patient is given additional techniques that increase the process of expectoration of exfoliated sputum.

These activities include:

breathing exercises;
special manual massage;
turning the patient every 3-4 hours.

Preventive actions

Proper and timely care of a victim who has had a stroke can reduce the risk of developing pneumonia.

the back of the bed should be raised at an angle of 30 degrees;
alternating flips from one side to another at least 7 times a day;
high-quality cleaning of the water that the patient drinks;
massage or kneading of the back, which allows you to induce a cough and increase the quality of expectoration;
brushing teeth and caring for the oral cavity;
good hygiene practices;
taking care of medical items;
airing the hospital room, which will reduce the number of germs in the air.

Immediately after discharge, it hurts him to start exercising, which will improve coughing and quickly remove sputum. Properly following the doctor's advice will help you quickly restore the body and your own health, as well as avoid complications.

What to do if pneumonia occurs after a stroke

Pneumonia after a stroke is a common and dangerous complication that occurs in half of all patients who have suffered a severe cerebrovascular accident. The success of therapy depends on a timely diagnosis and an accurate determination of the cause of the pathology. The inflammatory process in the lungs develops against the background of a disturbed blood gas composition. A stroke affects the functionality of all organs and systems, especially the respiratory organs, the control center of which is located in the brain stem.

Development mechanism

Pneumonia in stroke occurs in bedridden patients due to a violation of the quality of breathing. The loss of quality control of inhalation and exhalation leads to stagnation in the lungs, in addition, a weakened body is not able to fight many bacteria and microorganisms that can provoke pneumonia.

It can be:

Enterobacter and Klebsiella;
coli Escherichia or Pseudomonas aeruginosa;
staphylococcus aureus.

Exudate accumulated in the alveoli, difficult sputum discharge, the release of white and red blood cells lead to disruption of gas exchange, and prolonged immobility causes congestion in the pulmonary circulation. Pathogenic microorganisms actively multiply and contribute to the occurrence of the inflammatory process.

Another reason for the onset of the inflammatory process in the lungs is the penetration of juice from the stomach or even particles of vomit into them at a time when the patient is unconscious after apoplexy.

This is aspiration pneumonia, which occurs due to the cessation of the functionality of a certain area of \u200b\u200bthe lung tissue. Self-regulation and self-defense of the body of a patient who has suffered an apoplexy are violated.

In most cases, patients do not have a cough reflex, in respiratory tract sputum accumulates, in which pathogenic bacteria and microorganisms multiply. In this case, several days are enough for the development of inflammation in the lungs.

Another type of pneumonia is congestive. It manifests itself in patients who have lost the ability to move and long time remaining in one (lying, horizontal) position. Even regular massage does not help restore normal blood flow. Stagnation and impaired blood supply to the lungs lead to an inflammatory process.

Often, in the acute period of the disease, the patient needs artificial lung ventilation, which also contributes to the occurrence of pneumonia, but the most significant reasons are a change in blood flow and a violation of the functionality of muscles, including those supporting breathing.

Diagnosis and most striking symptoms

Suspicion of pneumonia after a stroke occurs when, a few days after apoplexy:

the temperature rises slightly and keeps without falling;
breathing becomes shallow, frequent and difficult;
both on inhalation and exhalation, pronounced wheezing and gurgling are heard;
breathing is especially difficult;
clearly audible shortness of breath in a motionless patient;
a dry tearing cough after a couple of days turns into a wet one, and streaks of blood are visible in the sputum;
despite the abundant content of sputum in the bronchi and lungs, the cough is either weak or absent altogether.

The danger of the disease lies in the fact that early pneumonia occurs against the background of pronounced symptoms of the underlying disease and it is not always possible to diagnose it in a timely manner. Early pneumonia is accompanied not only by a rise, but also by a decrease in body temperature to 35 ° C due to a violation of the functionality of the thermoregulation center in the brain.

In order to confirm a preliminary diagnosis, a detailed examination will be required, including:

A blood test that determines the number of leukocytes and the erythrocyte sedimentation rate. The number of leukocytes may be markedly reduced due to a reaction to brain damage.
X-ray, which can detect changes in lung tissue. Such foci are not always visible on the pictures immediately, so the examination is carried out several times and in several projections.
Blood biochemistry shows failures in gas and acid-base balance. With the help of this study, a protein of the inflammatory process is detected in the blood.
Sputum culture.
Bronchoscopy.
CT scan.

Therapeutic measures and prevention

Inflammation of the lungs that occurs after a stroke requires special approach. Taking into account the serious condition of patients, the forced lying position, minimal mobility or its complete absence, treatment tactics are selected taking into account the severity of the condition and the age of the patient, the presence of concomitant diseases and the severity of violations from nervous system.

For effective treatment, the doctor may prescribe:

antibiotics;
medicines to support respiratory function;
means for preventing the development of cerebral edema;
drugs that improve the drainage function of the bronchi.

There is also the so-called symptomatic therapy, which includes taking medicines, which have an analgesic effect, support the heart muscle, relieve a painful cough. The goal of therapy is not only the elimination of the causes of the inflammatory process, but also the removal of intoxication, support and enhancement of immunity.

Along with drug treatment of great importance is the performance by patients of therapeutic exercises, massage sessions, physiotherapy procedures. Regarding the appointment antibacterial drugs, then there is no need to wait for the results of the sputum examination. Stasis after the doctor diagnosed pneumonia after a stroke, patients are prescribed a course of antibiotic therapy.

You can avoid pneumonia after apoplexy by taking care of compliance simple rules patient care:

The head end of the bed should be raised.
The position of the patient must be changed at least 4 times a day.
At least twice (in the morning and in the evening) during water procedures and wiping, rub the skin on the patient's back with camphor alcohol.
Massage the chest daily (if necessary, do cupping massage).

What causes pneumonia after a stroke, what is dangerous and how it is treated

Stroke is primarily dangerous complications caused by acute insufficiency of blood supply to the brain. One of the most common consequences of a hemorrhagic or ischemic attack is the development of congestion.

Why does pneumonia occur during a stroke?

Stroke and pneumonia go hand in hand and occur in almost half of patients with brain damage. There are several factors that increase the likelihood of developing apoplexy:

Most often, pneumonia after a stroke develops in bedridden patients. But, apoplexy can also occur in patients who have retained some motor functions.

Types of pneumonia in stroke

The prognosis of the consequences of pneumonia after a stroke depends on what caused the violation. According to the ICD, there are two main types of apoplexy.

Aspiration pneumonia - develops due to the ingestion of pieces of food in the respiratory tract of a person. As a result, the affected segment of the lung tissue stops working. Bacteria in the airways cause inflammation.

Signs of aspiration pneumonia have manifestations similar to intoxication or poisoning of the body. The first symptom is a painful cough. Radical pneumonia is most difficult to diagnose, as the inflammation spreads to the paramedial space.

The most dangerous thing is when large bronchi are blocked by pieces of food. It hurts the patient to cough, and eventually pneumonia develops with fever.

The accumulation of a viscous and thick liquid contributes to the spread of pathogenic bacteria and the development of purulent pneumonia of the lungs.

In both cases, violations lead to the need to connect to a ventilator, during the entire period drug therapy.

What is the danger of pneumonia in a stroke

Treatment of congestive pneumonia in bedridden patients on the background of a stroke is not always started in a timely manner. Early diagnosis of lung damage improves the prognosis of therapy. The difficulty in determining pathological changes often lies in the fact that the first signs of congestion are mistakenly attributed to the consequences of a stroke.

Complete or partial loss of respiratory function - connection to a ventilator is required, the patient's rehabilitation is difficult, since a normal supply of oxygen to the body is necessary for recovery.

Signs of intoxication from congestive pneumonia do not have pronounced manifestations and are not determined using clinical analyzes blood. Leukocytosis is either completely absent or only slightly observed.

Treatment of pneumonia in bedridden patients after a stroke is difficult due to the serious condition of the body. An important part of traditional therapy is the application of preventive measures or the prevention of complications after brain damage.

How to prevent post-stroke pneumonia

Understanding the clinic of congestive pneumonia and its pathogenesis made it possible to provide a number of preventive measures designed to prevent the development of the inflammatory process. The following preventive measures are required:

Reducing the pathogenic factor - the prevention of pneumonia largely depends on the efforts of the medical and hospital staff to ensure the necessary conditions to reduce the unfavorable flora of the upper respiratory tract. Daily sanitation and physiotherapy are carried out.

How can pneumonia be treated after a stroke?

Pneumonia, as a complication after a stroke in the elderly, is difficult to treat due to almost total absence the body's own reserves to fight the disease. The course of therapy has to be repeatedly adjusted. Even a well-conducted treatment does not guarantee that secondary inflammation of the lungs will not develop over time.

Relief of swelling of the brain.

To achieve the goals, they use: diuretics, cardiotonics, mucolytics, physiotherapy and breathing exercises. A course of antibiotic therapy is mandatory, with adjustment of drugs every 72 hours.

Features of pneumonia as a complication after a stroke

Pneumonia in stroke is the leading cause of death in patients with stroke. Immediately after a stroke, every fourth patient, and within a month, every eighth begins pneumonia. What are the causes, symptoms, prognosis and treatment for this diagnosis?

Reasons for development

Due to a stroke, left without oxygen for a while, certain areas of the brain are affected. Because of this, there may be a violation of the functions of blood flow in the pulmonary circle, dysfunction of the diaphragm and the drainage system of the lungs.

All this, as well as a depressed immune system, allows sputum to accumulate in the lungs and airways, causing inflammation and creating a favorable environment for the reproduction of pathogenic microorganisms.

The position of the patient lying on his back and the absence of a productive cough accelerates the dynamics of the disease, which makes expectoration of sputum almost impossible.

Patients at risk:

people with a reduced level of immunity (kidney disease, liver disease, heart disease, etc.);
overstepped the age threshold of 65 years;
with chronic or acute diseases oral cavity, nasopharynx;
having excess weight;
in the presence of systemic diseases;
if ventilation of the lungs by the hardware method was carried out for more than 6-8 days;
when the patient is immobile for a long time;
if due to a stroke there is difficulty in breathing or in blood flow in a small circle.

These are not all the causes of foci of inflammation in the lungs. Thus, there are frequent cases of bacterial infection of patients after the use of invasive methods of resuscitation, poor disinfection of air conditioners and humidifiers, as well as in the absence of necessary care behind the patient.

But even in the presence of any of the above factors, timely preventive measures can prevent the development of pneumonia. But it can be difficult to recognize the clinical picture, as well as to make a prognosis of the course of the disease.

Symptoms and diagnosis

It is almost impossible to notice the manifestations of pneumonia in the early form (which occurred in the first 72 hours after a stroke). This is due to such a disturbed general condition after a stroke that the clinical picture of pneumonia is quite blurred and difficult to diagnose.

But there are still some typical symptoms:

a slight increase in overall body temperature;
wheezing and nonspecific sounds (gurgling, gurgling) when breathing;
obvious changes in the tissues of the lungs on x-ray;
In blood tests, as a rule, there is an increase in the level of leukocytes.

Cough in most cases is absent or mild and ineffective.

But with a late form of pneumonia (the occurrence has to be put on), the symptoms are more pronounced:

temperature indicators increase to 38-39.5 0 С;
chills are observed;
cough may be present;
sputum becomes purulent;
in blood the expressed leukocytosis is found.

At the slightest suspicion of the occurrence of pneumonia, the patient is given a sputum sample to identify the pathogen, and the doctor will also recommend an X-ray examination ( computed tomography or conventional plain chest x-ray).

If you notice signs of pneumonia, you can early stages, then promptly started treatment gives hope for a positive prognosis.

If the use of x-rays is not possible due to the severe course of the underlying disease, then the diagnosis is established on the basis of general symptoms, as well as available laboratory data. After confirming the diagnosis and prescribing treatment, a blood test is collected daily and a number of other general studies are performed to monitor the dynamics of the disease.

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Treatment

The appointment of drug therapy should occur immediately after the diagnosis is confirmed. Antibiotics with a broad spectrum of activity are used at the beginning of treatment, and after the pathogen and its resistance to drugs are accurately established, the prescription of drugs may change.

The most common causes of inflammation are:

gram-negative microflora;
staphylococci;
fungal infection;
Pseudomonas aeruginosa;
anaerobic bacteria.

Depending on the type of pathogenic microflora, treatment can take from 10 to 45 days.

At the same time, they are not limited to the appointment of monotherapy (that is, only one drug). Usually, expectorants, sputum-thinning, diuretic drugs, as well as drugs that excite the cough center (if the patient's condition allows it) are added to the main drug.

If pneumonia was caused by food entering the pulmonary tract, vomiting, or a swallowing reflex is impaired due to a stroke, then food is administered to the patient directly into the stomach through a tube. But at the same time, a prerequisite is the treatment of the mouth and teeth several times a day with antimicrobial solutions.

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In severe cases, with a large amount of accumulated sputum, it may be necessary to remove it by invasive methods (using a long needle and syringe) using local anesthesia. This procedure can be repeated several times until the condition improves.

All drugs in the first days are administered mainly intravenously, and then gradually move to oral administration.

Also, along with drug therapy, additional procedures are carried out to increase the effectiveness of coughing and expectoration of secreted mucus:

special vibration massage manual or hardware method;
breathing exercises;
changing the position of the patient every 2.5-3 hours.

In modern methods of treatment, it is possible to use immunomodulating drugs, as well as agents that promote detoxification.

Supportive procedures also include physiotherapy with the use of bronchodilators.

With adequate and timely treatment, the prognosis is quite favorable. But the older the person, the less chance for a positive outcome. So, according to statistics, every 10 cases of pneumonia after a stroke in elderly people ends in death.

How to avoid pneumonia?

Proper and meticulous care of a stroke patient can reduce the risk of pneumonia.

coups alternately on each side 5-7 times a day;
sanitation of the oral cavity, as well as brushing teeth after eating;
massage of the upper back to induce coughing and effective expectoration;
setting the back of the bed at an angle;
enough frequent airings rooms to reduce the number of microbes in the inhaled air;
additional purification of consumed water;
careful personal hygiene of medical personnel, timely disinfection of tracheostomy tubes, humidifiers, etc.

Exercise should begin immediately after the permission of the doctor, so the cough will become more productive, and blood circulation in the small circle will improve significantly. This approach is one of the most effective methods prevention and elimination of congestion after pneumonia.

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Stroke and pneumonia - you can't think of anything worse

A stroke in itself is a serious disease that can easily make a bed invalid out of a person. What can I say, when after one "hit" on health follows a second, no less serious - pneumonia. The congestive variant of this disease most often develops, which is a complication of a previous stroke.

According to statistics, the incidence of pneumonia after a stroke is from 35 to 50%. Approximately 15% of cases of complications of pneumonia is the cause of death. It would seem that a person survived after one illness, but could not cope with the second. Any pneumonia with a stroke has its own causes, it makes sense to deal with them in more detail.

Risk factors

Any disease, including pneumonia after a stroke, has its own causes and risk factors. Such knowledge will help prevent complication and prevent its occurrence in principle.

Often with inflammation of the lungs after a stroke, elderly people and old age. Their normal drainage function of the lungs is disturbed, and after a stroke, sputum separation is practically absent, especially if the disease is severe. The risk of pneumonia increases significantly after a person is 65 years old.

Excess weight itself is a predisposing factor for the development of stroke. In the case of a complication in the form of pneumonia, the chances are much higher. Pneumonia can occur in people who had chronic forms of heart and lung disease before the stroke.

After a stroke, a person can often be in a coma, which contributes to the development of a congestive process in the lungs. The cause of this condition is a violation or complete absence of outflow of sputum. Similar state occurs with prolonged artificial ventilation of the lungs, which is carried out in the absence of spontaneous breathing. Often a week is enough for pneumonia to develop. Sometimes even in the mind the patient is on bed rest, which contributes to stagnant processes in the pulmonary system.

Development mechanism

It is no secret that the prognosis after a stroke is often sad. There are some reasons that trigger the pathological mechanism of the development of the disease. They consist:

in an oppressed mind for a certain time;
central respiratory dysfunction;
lack of active movements;
violation of the blood supply to the lungs.

The degree of damage depends on the massiveness of the damage to the brain tissue, as well as the place where the hemorrhage or blockage of the vessel occurred. As a result, the function of sputum drainage from the lungs suffers in some patients. Reduces or absent cough reflex or urge to cough, it is he who is protective and promotes sputum discharge. There is a replacement of microorganisms with more aggressive ones that can cause disease. Further, it is just a matter of time and the disease does not take long to wait, the inflammatory process develops rapidly.

Other factors

But not always artificial ventilation of the pulmonary system after a stroke is the cause of the development of the disease. Often an infection joins, which is constantly in the hospital, especially in the intensive care unit. The level of immune protection also decreases, the body is not able to resist infection.

Symptoms of the disease

Diagnose pneumonia after a stroke, even at present stage development of medicine is very difficult. The problem remains open for the next generations of doctors. It is difficult diagnosis that is the factor that contributes to human mortality. In general, manifestations can be easily veiled by the primary disease.

Some of the symptoms may turn on:

the temperature rises moderately;
type of breathing disorder pathological variant Cheyne-Stokes or Kussmaul;
as a result of a violation of the cough reflex, there is no sputum separation;
on auscultation heard wheezing of various calibers.

Features of aspiration pneumonia

This variant develops as a result of food particles entering the respiratory tract. After such a segment of the lung ceases to perform its function normally, and the bacteria that are there are rapidly developing.

With aspiration pneumonia, the manifestations resemble intoxication or poisoning. Initially draws on a cough, which is excruciating. The hilar variant of aspiration pneumonia is difficult to diagnose. A high temperature joins, it becomes painful to cough. A dangerous option is the situation when a large bronchus is blocked by pieces of food.

Late symptoms

Diagnosis of the late version of the disease is much easier. To make a proper diagnosis, a doctor will need certain symptoms. Among them it is worth noting:

rapidly developing fever, numbers above 38 degrees;
in a blood test, an increased number of leukocytes is of interest;
pus is present in sputum or discharge from the trachea;
pathological changes in the lung tissue are clearly visible on the x-ray.

Final diagnosis

Beyond the symptoms, there are some standards instrumental diagnostics Problems. Initially, it is worth listening to the chest with a phonendoscope, if there is a suspicion of pneumonia, then an X-ray examination of the lungs is prescribed. In the picture, in addition to stagnation, the most intense focus of shading will be clearly visible.

The sputum or washings from the bronchi are subject to research. This analysis will determine the type of pathogen, after which its individual sensitivity to antibacterial drugs is carried out. This analysis will later allow the doctor to prescribe an effective treatment.

Treatment

In case of pneumonia, which could complicate a stroke, measures are aimed at eliminating hypoxia as soon as possible. The tissues should receive more oxygen, this is done with the help of artificial ventilation of the lungs or the use of oxygen pillows. It is necessary to pay attention that pulmonary edema often joins, which is why prevention of this condition is carried out.

In parallel, the treatment of the underlying disease is carried out, which is prescribed by a neuropathologist. After establishing the type of pathogen and its sensitivity to antibiotics, appropriate drugs are used. Prior to this analysis, broad-spectrum antibacterial drugs are indicated. The dose of the antibiotic is selected individually, but, as a rule, they are used in large quantities.

IN without fail diuretics are used, they help reduce swelling and prevent pulmonary edema. Cardiac preparations and expectorants are indicated. If there are problems with expectoration due to its viscosity, the doctor may prescribe drugs to thin it.

Additionally

After stabilizing the condition for a stroke, physiotherapy is recommended for a person. Excellent helps to remove sputum electrophoresis with potassium iodide. Exercise therapy is also shown under the guidance of an instructor, it is mainly aimed at restoring breathing.

Even in bed, the doctor may recommend breathing exercises to a person. If the patient is able to breathe on his own, then in bed he is recommended to inflate balloons. Special drainage positions are also used to help expel sputum from the lungs. Massage in the acute period is undesirable, but in a mild form it helps to remove sputum and is carried out by a massage therapist.

Prevent pneumonia

When there is an understanding of the mechanism of the development of the disease, it is possible to prevent the development of the disease. Based on this, certain preventive measures were developed, the observance of which will reduce the risk of developing the disease. An approximate list of them can be presented as follows:

It is worth reducing the pathogenic factor, because the risk of developing the disease largely depends on medical workers, the quality of their performance of their duties. In the intensive care unit, in addition to processing instruments and surfaces, sanitation of the bronchial tree is mandatory.
It is required to carefully observe the rules of hygiene, including personal. Medical workers it is worth adhering to the rules of asepsis and antisepsis.
The tube that is used for ventilation of the lungs must be for individual use and after use it is processed and disposed of. The same applies to the rest of the instruments that can come into contact with the human respiratory system.

Prevention

There are some steps you can take to help prevent the development of pneumonia after a person has had a stroke. Some moments will require efforts from the carer and staff, but then they will fully justify themselves.

Initially, it is worth ensuring a constant supply of fresh air. This can be done by ventilating the room, but with certain precautions to prevent hypothermia. A person should be covered with a blanket, and in the cold season with several.

Oral hygiene is mandatory, when a person is unable to cope with it himself, those who care for him help him. To prevent stagnation, the position in bed changes every two hours. In the normal state of the patient, he is given a semi-recumbent position at an angle of 45 degrees.

Additionally, breathing exercises are shown, which is carried out no earlier than one and a half hours after the last meal. It is useful to inflate baby balloons. Additionally, a special massage is performed for about three sessions throughout the day.

As the symptoms of a stroke regress, a person must be activated, first in bed, and then within the ward. This approach will prevent the accumulation of sputum and prevent congestion.

What to do with pneumonia after a stroke?

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

Clinical picture

Factors contributing to the development of pneumonia after a stroke:

age (over 65 years);
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.

Reasons for the development of the disease:

Experts identify the following symptoms of the disease:

defeat of the 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:

golden staphylococcus aureus;
coli;
klebsiella;
Pseudomonas aeruginosa.

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

The disease is diagnosed 2-3 days after hospitalization. The patient's central nervous system regulation is disturbed, edema appears in the lungs. The forecast depends on localization of the center. Late pneumonia (2-6 weeks) develops against the background of hypostatic processes. She is difficult to diagnose. Complications of the disease can lead to death.

The symptoms of pneumonia appear as high temperature body, pathology of cough, wheezing. How long the temperature lasts in an adult depends on the severity of the course of pneumonia. Main clinical and laboratory parameters:

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

Therapy Methods

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 type of pathogen identified, the sensitivity of the virus to chemotherapy.

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

The patient is prescribed mucolytics, diuretics, cardiotonic drugs, expectorants. It is recommended to carry out physiotherapy, do breathing exercises. If the patient has urinary incontinence, then catheterization is performed Bladder. Prevention of inflammation of this system consists in strict observance of the rules of personal hygiene, washing the bladder, 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, an additional examination of the patient will be required. A similar phenomenon is observed as a result of prolonged immobility and active phase rheumatism. For prevention, experts recommend early passive and active movements.

At severe course diseases can necrosis of integumentary tissues. If this process penetrates deep, the wound becomes infected, the body becomes infected. Prevention of bedsores is to regularly change the position of the body (1 time in 2 hours). The skin is treated with warm camphor alcohol. If pneumonia disrupted the work of the large intestine, you will need to follow a diet. The diet includes fiber and dairy products. For constipation, take a laxative. Drink up to 2 liters of fluid per day.

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

To prevent pneumonia after a stroke, it is recommended:

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

You can not take antibacterial drugs to prevent pneumonia.

Pneumonia during and after a stroke

Why does pneumonia occur?

The high incidence of pneumonia in these patients is due to several factors. Patients with severe ischemic stroke have extensive brain damage. As a result of the oppressed consciousness, the protective mechanisms of the body get lost. The brain is out of control internal systems and organs, stops regulating the course of important biochemical processes. But what is especially fatal with such a lesion is that the body loses its ability to heal itself.

The imbalance of the entire system contributes to the weakening of the immune system and the rapid development of pneumonia during a stroke or after it. The impetus for the occurrence of pneumonia are violations in the work of the respiratory system, in particular:

Failure of swallowing and cough reflexes
Decrease in the rate of blood microcirculation in the bronchi
Respiratory supply interruption nutrients and oxygen
Violation of the functioning of the drainage system of the bronchi
Displacement of normal microflora by pathogenic, contributing to the development of infection.

exacerbates the patient's condition ischemic stroke or after it a forced permanent lying position. As a result, the diaphragm, which helps the lungs pump blood, ceases to function. The fluid accumulating in the lungs becomes a breeding ground for the development of pathogenic microorganisms and then pneumonia.

What contributes to pneumonia

Factors that accelerate the development of pneumonia after ischemic stroke include:

Old age (over 65 years old)
Long-term (more than 7 days) artificial lung ventilation
Overweight patient
Chronic cardiovascular diseases
Pathologies of the respiratory system
hyperglycemia
Uremia
Long stay in the hospital
Lying state
Taking certain medications.

Difficulties in diagnosis

Even today, with the availability of modern equipment, it is extremely difficult to diagnose pneumonia in patients with ischemic stroke in time. The main difficulty lies in the fact that the symptoms of inflammation in the early stages of a stroke are often mistaken for signs of an underlying disease. A delayed diagnosis of pneumonia leads to the fact that by the time the diagnosis is made, the disease has already taken a severe form or caused complications.

It is much easier to determine the inflammation that has arisen against the background of an improvement in the condition of the underlying disease. In this case, the picture is clearer, and doctors quickly navigate the diagnosis. At severe stroke the symptoms of pneumonia tend to be more vague and therefore difficult to identify.

How does pneumonia develop?

Patients admitted to the hospital with ischemic stroke most often develop hospital-acquired pneumonia. That is, pneumonia manifests itself a few days after a stay in a medical facility. This does not include patients with pneumonia who at the time of admission already had lung lesions or the infection was in the incubation period.

Early pneumonia develops on 2-3 days of being in the hospital. The reason for its development are violations in the regulation of the central nervous system.

The disease is manifested by fever, the appearance of wheezing during breathing, shortness of breath. Cough is usually absent due to inhibition of the cough reflex. The occurrence and severity of complications depends on which part of the brain is affected and how severely.

Late pneumonia develops after 2-6 weeks in the hospital. It is provoked by hypostatic processes arising from the supine position. The normal circulation of blood in the small pulmonary circle is disturbed, fluid accumulates in the lungs. The disease is difficult to diagnose, and as a result of delay in treatment, death can occur.

Symptoms of pneumonia are manifested in the form of high fever, cough, wheezing in the bronchi. Their severity depends on the patient's condition, his immunity and the stage of the disease. When determining the disease, doctors are guided by the presence / absence of fever (temperature rise to 38 ° or decrease to 36 °), the number of leukocytes in the blood, the development of purulent processes in the trachea, and changes in the gas composition of the blood.

Laboratory and X-ray studies are used to make a diagnosis.

Treatment of pneumonia

The main directions of therapy:

Suppression of the inflammatory process
Neutralization of infection
Prevention of cerebral edema
Restoration of the drainage function of the bronchi
Resuming normal lung function
Immunity Boost
Prevention or treatment of complications.

To suppress the inflammatory process, drugs with antibacterial action are primarily prescribed. The appointment is made based on the patient's condition, determining the type of pathogen, its resistance to drugs, the presence or absence of an allergic reaction in the patient, concomitant diseases.

Unfortunately, even in the presence of well-equipped laboratories, it is possible to immediately determine the cause of the disease only in % of cases. The situation is complicated not only by the presence of several pathogens, but also by their resistance to drugs that has developed in hospital conditions. But in order to prevent the aggravation of the disease and the development of complications, it is extremely important to correctly and timely prescribe drugs.

The effectiveness of the treatment is checked after 1-5 days using laboratory or microbiological studies, and, if necessary, the treatment regimen is adjusted. The performance indicators are:

Temperature drop
Decreased amount of purulent sputum
Decreased leukocytosis
Slow down or stop the inflammatory process.

Further appointment is made on the basis of the data obtained from the previous treatment. The duration of the use of antibiotics can take from 5 days to one and a half months - depending on the type of pathogen, the severity of the patient's condition.

To improve the patient's condition, it is of great importance to take measures to improve the drainage function of the lungs. To do this, drugs with expectorant and mucolytic effects are prescribed, physiotherapy is carried out: massage, breathing exercises.

In a severe form of the disease, patients undergo plasma transfusion, and detoxification therapy is prescribed.

Methods for preventing pneumonia after a stroke

To prevent the development of pneumonia in patients with ischemic stroke, it is necessary:

Provide fresh air: ventilate the room more often, taking the necessary precautions to prevent hypothermia of the patient.

Perform oral hygiene. This will prevent the development of infection. If the patient is not able to independently carry out the procedures, you will need to help him with this.

Frequent change of position: it will be necessary to turn the patient every two hours to ensure normal air movement and reduce congestion.

If the patient's condition allows, he needs to provide a semi-recumbent position (at an angle of 45 °) - it will improve ventilation of the lungs.

Therapeutic massage is necessary to improve the separation and release of sputum. The session is held three times a day.

Breathing exercises. To restore the functions of the respiratory organs, inflating balloons or children's toys helps a lot. The procedure is recommended to be carried out as often as possible, one and a half hours after eating.

Banks or mustard plasters.

Early activation of the victim. Doctors recommend stimulating the patient to do breathing exercises, and, if possible, to roll over on their own, take sitting position. The start of rehabilitation exercises is determined by the doctor, based on the patient's condition.

The prognosis for treating pneumonia in people with or after a stroke depends on many factors. Of great importance is the prevention of the disease, timely diagnosis, proper treatment.

Pneumonia after a stroke develops in 34-50% of all patients who have brain damage. Most often, pneumonia in stroke is a complication or concomitant disease. Such a condition sharply worsens the patient's condition, threatens his life. In 15% of cases of stroke followed by pneumonia, the death of patients was recorded, despite the therapeutic measures taken.

The occurrence of damage to the respiratory system

Stroke and pneumonia develop in a patient almost simultaneously.

Apoplexy along with pneumonia manifests itself in people in the presence of the following factors:

The patient is over 40 years old.
The person is overweight.
The patient had previously had pneumonia and was diagnosed with diseases of cardio-vascular system.
The patient is in a coma.
During treatment for any disease, a person was connected to an artificial lung ventilation system for a long period.
In bedridden patients after a stroke with prolonged hospitalization with adynamia, dangerous lesions of the respiratory system develop.
Some medications taken by stroke patients, such as H2 blockers, can cause symptoms of pneumonia.

After a stroke, the appearance of inflammation in the respiratory system in bedridden patients is most often recorded. This is due to a sharp decrease in immunity.

The prognosis of the consequences of the development of pneumonia on the background of a stroke depends on the factors that caused the development of brain damage. Doctors distinguish 2 types of apoplexy of this kind.

The first type of disease is aspiration pneumonia. It develops due to the ingress of various pieces of food into the patient's respiratory canals. At the same time, the segment of the lung where these fragments of food fall ceases to function normally, and the bacteria that have penetrated into this area provoke an inflammatory process.

Symptoms of aspiration pneumonia are similar to signs of poisoning or intoxication. At first, a painful cough develops, and then the body temperature rises to 37-39 ° C

The danger increases if pieces of food get into the respiratory canals, which block the large bronchi. Then it is difficult for a person to cough due to severe pain.

The second type of damage to the respiratory system after a stroke is congestive (hypostatic) pneumonia. Most often, this type of lesion develops in bedridden patients. A long period finding the body in a horizontal position causes a violation of blood flow in the pulmonary circulation of the lung. The accumulation of a viscous fluid in the organ begins, because ventilation worsens, the drainage system does not work well. Due to the accumulation of sputum, microbes spread that provoke the development of purulent inflammation of the lung.

What can cause pneumonia with brain damage

It is necessary to treat the defeat of the respiratory system in a patient lying down due to a stroke immediately after the diagnosis is made. With timely early diagnosis disease forecasts for the survival of the patient increase dramatically. The complexity of the correct diagnosis lies in the fact that the first pathological changes in the respiratory organs are often attributed to the consequences of brain damage.

A patient can easily become infected with pneumonia even in a hospital environment. For this, only pathogens (staphylococcus aureus) and insufficient blood supply to the brain and respiratory organs are needed.

If signs of incipient pneumonia are detected in time, then the patient is connected to a ventilator. In this state, he will be throughout the course of drug therapy. To determine the causes that led to the defeat of the respiratory system, doctors conduct differential diagnosis. The type of apoplexy and the type of causative agent of the inflammatory process in the lung are determined. This is necessary for the selection of optimal therapy.

If adequate measures are not taken, then complications of the following nature will arise:

The patient has a loss of respiratory function. It can be partial or complete. Therefore, a person is connected to a ventilator. It is necessary to supply the patient's body with oxygen until complete recovery.
If pneumonia is not completely cured, then the development of intoxication of the human body is possible. Such poisoning greatly affects the functioning of the cardiovascular system. Congestive pneumonia has no obvious symptoms and is difficult to diagnose with blood tests.
If a person develops undiagnosed congestive pneumonia during a stroke, most often such a patient dies. Half of people with a stroke survive from aspiration pneumonia.

It is recommended to take preventive measures to prevent subsequent complications. It should be taken into account that it is possible to develop bilateral pneumonia on the lungs in stroke patients when they are in the hospital. This is the most dangerous complication, because a person loses consciousness, and then a coma develops. Therefore, doctors must strictly monitor the condition of the patient's respiratory system in order to take timely measures.

Preventing and Treating Pneumonia After a Stroke

Preventive measures to combat congestive pneumonia are designed to prevent the development of inflammatory processes in the patient's respiratory system. To do this, doctors and orderlies carry out daily sanitation of a person, take him to physiotherapy procedures. This reduces the pathogenic factor, leads to a sharp decrease in the pathogenic flora on the upper respiratory canals of the patient.

An important component of preventive measures is the observance of all hygiene rules, since in most cases the appearance of symptoms of pneumonia in a patient during the treatment of a stroke is a consequence of non-compliance with the rules of asepsis and antisepsis by the hospital workers themselves.

Pneumonia can occur due to the use of connecting the patient to artificial ventilation equipment through old samples of breathing tubes. Therefore, it is recommended to use modern samples of tracheotomy tubes, which do not allow the development of the inflammatory process.

If a respiratory disease has developed after a stroke in an elderly person, then it is very difficult to cure the lesion, since the body of such a patient has practically no reserves. For such people, it is necessary to constantly adjust the course of therapy, because even if the doctor correctly carried out all the therapeutic measures, there is no guarantee that pneumonia will not reappear.

Treatment of people with the described complications is reduced to the fight against various congestion in the respiratory system. At the same time, doctors stop the swelling of the patient's brain structures.

For treatment, diuretic drugs, mucolytic drugs, cardiotonic drugs are used. The patient is given sessions of physiotherapy, he is prescribed breathing exercises. Treatment is carried out with antibacterial agents, and to achieve the result, doctors adjust their use every 3 days.

The prognosis for successful elimination of pneumonia depends on general condition person and the timeliness of detection of damage to his respiratory system.

In contact with

Pneumonia after a stroke is considered quite common and can develop in 30-50% of patients. Inflammation of the lungs provokes a sharp deterioration in the health of the patient and is accompanied by severe headaches. In addition, such a complication poses a threat to the patient's life and in 15% of cases leads to death, even despite the quality of medical care.

How and why it develops

In most cases, stroke begins to develop bacterial pneumonia. It occurs against the background of uncontrolled reproduction in the body Staphylococcus aureus, Klebsiella, Escherichia and Pseudomonas aeruginosa, etc.

Risk factors for pneumonia after a stroke include:

Availability overweight(obesity);
the presence of severe types of stroke;
performing artificial ventilation of the lungs, which is carried out for a long time.

In addition, long-term use of antacids and H2-blockers, as well as maintaining a sedentary lifestyle (this includes bedridden patients) can contribute to the defeat of the respiratory center.

In bedridden patients after a stroke, pneumonia is formed as a result of the development of congestive processes in the lungs. This is due to the fact that when the body is in a horizontal position for a long time, blood stagnation forms in the vessels of the body. In case of violation of the venous outflow of blood in the alveoli of the lungs, sweating of the liquid component of the blood occurs. This leads to the fact that the alveoli begin to fill with sputum, and the lungs can no longer perform full gas exchange.

If a person loses consciousness during a stroke, gastric juice or vomit can get into his respiratory tract. This can also lead to the development of pneumonia.

Stroke and pneumonia can cause death if the patient is not provided with timely health care.

Treatment

Treatment of pneumonia should be aimed at eliminating oxygen starvation(hypoxia), inhibition of the development of pathogenic microorganisms and restoration of respiration.

Pneumonia in stroke is treated with the use of:

Antibacterial therapy. If the disease is at the initial stage of development, then the patient may be prescribed Ampicillin or Ceftriaxone. If the inflammatory process in the lungs has a neglected development, then its treatment will be carried out by taking Meropenem, Tobramycin or Ciprofloxacin. In order to increase the effectiveness of treatment, you can combine the intake of certain antibacterial agents. The duration of antibiotics can be different and depends on the severity of the disease.
oxygen therapy. It is carried out with the help of mechanical ventilation (artificial ventilation of the lungs) and is designed to maintain respiratory function in a normal state. In addition, mechanical ventilation prevents the occurrence of hypoxia, restores the gas composition of the blood and normalizes the acid-base balance in the body.
Mucolytic, bronchodilator and bronchodilator drugs (Bromhexine, Acetylcysteine, etc.). Such medicines help to remove mucus from the lungs.
Immunomodulating agents. These include Timalin, Decaris, etc.
diuretic drugs. By taking diuretics, you can remove excess fluid from the body and normalize blood pressure.

In addition, in order to speed up the process of removing sputum from the lungs, the patient may be assigned to perform special procedures. It may be a complex breathing exercises, restoring the functions of breathing, vibration or manual massage chest.

5 days after the start of treatment, the doctor must conduct a diagnosis in order to evaluate the effectiveness of the therapy. The effectiveness of the treatment course will be evidenced by the intensive removal of sputum from the respiratory tract, a decrease in leukocytosis and body temperature.

Consequences and predictions

Pneumonia is dangerous because its development can be accompanied by various complications. If the treatment of the disease is not carried out properly, then the sick person may experience the following problems:

Decreased contractility of the lungs. At the same time, the violation of the contractility of the lungs can be complete (when a person is not able to take a breath) or partial (when it is possible to take a breath, but with great difficulty).
Intoxication (poisoning) of the body. Most often occurs against the background of untreated pneumonia. Intoxication renders negative impact on the functioning of all human organs and its cardiovascular system.
Congestive pneumonia. If inflammation of the lungs was not detected in time, then its further progression can cause the death of lung tissue. In most cases, advanced pneumonia leads to the death of the patient.

The favorable prognosis depends on the severity of pneumonia at the time of its treatment. The sooner a disease is detected and treated, the more chances a person will have to overcome the disease.

Inflammation of the lungs is the most common complication of severe stroke. According to various literature data, pneumonia accompanies from 30% to 50% of all patients with stroke, and in 10%-15% it is the cause of death.

Risk factors for this complication include:

old age over 65;
excess body weight;
chronic lung and heart diseases;
a sharp depression of consciousness after a stroke (below 9 points on the Glazko coma scale);
prolonged mechanical ventilation for more than 7 days;
prolonged hospitalization and weakness;
taking a number of drugs (H2 blockers).

Why do lungs become inflamed during a stroke?

The pathophysiological causes of pneumonia after a stroke include:

oppression of consciousness;
central respiratory failure;
hypodynamic changes in blood flow in the pulmonary circulation.

Massive damage to the brain causes damage to the mechanisms of self-regulation and self-defense of the body. The drainage function of the lungs is disturbed, the cough reflex decreases, the normal microflora is replaced by highly virulent strains of nosocomial infection, which contributes to the rapid development of the disease.

Prolonged mechanical ventilation after a stroke or aspiration are also direct causes of pathogenic flora entering the respiratory tract.

The most common causative agents of pneumonia after a stroke:

golden staphylococcus aureus;
pneumoniae streptococcus;
Pseudomonas aeruginosa;
klebsiella;
enterobacter;
coli and other gram-negative pathogens characteristic of nosocomial pneumonia.

Pulmonary complications after stroke

Allocate early and late inflammation of the lungs, which differ in the mechanism of development. In the pathogenesis of early pneumonia, which occurs in the first 2-3 days of hospitalization, the decisive role belongs to the dysregulation of the central nervous system. The rate of development of the complication depends on the area of the brain in which the focus of ischemic or hemorrhagic changes occurs. At the same time, edema and foci of plethora are found in the lungs.

At a later date - 2-6 weeks, the main cause of the development of pathological inflammatory changes in the lungs are hypostatic processes.

Even at the current level of development of medicine, the diagnosis of pneumonia in the presence of a stroke remains an unresolved problem. Delayed correct diagnosis contributes to the development of a number of complications, which lead to death.

Symptoms of early pneumonia are veiled by manifestations of the underlying disease and are often non-specific:

increase in body temperature;
respiratory disorders - shortness of breath, pathological Cheyne-Stokes and Kussmaul;
cough is rarely observed due to inhibition of the central cough reflex;
with the development of pulmonary edema, bubbling breathing, fine bubbling rales are added.

Late pneumonia develops already against the background of positive dynamics in the neurological status and does not present such difficulties.

The main clinical and laboratory indicators of pneumonia are:

Fever above 38°C and temperature drop below 36°C;
Severe blood leukocytosis, less often leukopenia with a shift of the leukocyte formula to the left;
Purulent discharge from the trachea;
Focal changes in the lungs are detected during x-ray studies;
Violation of the gas composition of the blood.

Pneumonia is suspected when three of the above criteria are present, and a combination of four features allows the diagnosis of pneumonia to be made.

Therapeutic measures are aimed at suppressing the infection, stopping cerebral edema, and combating pulmonary edema.

Empiric antibacterial drugs are prescribed immediately after diagnosis and in high dosages, often combining drugs from different groups. After 72 hours, the choice of antibiotic is adjusted depending on:

the type of pathogen identified later;
the sensitivity of the strain to chemotherapy drugs;
body response.

In addition, diuretics, cardiotonics, expectorants, mucolytics are administered, oxygenation, physiotherapy, and breathing exercises are used.

Preventive measures and condition control

Preventive measures are as follows:

Reducing the amount of pathogenic flora in the upper respiratory tract - an elevated head end of the patient, daily sanitation of the nasopharynx and physiotherapy;
Compliance with the hygiene of therapeutic measures, the rules of asepsis and antisepsis;
The use of modern tracheostomy tubes and careful monitoring of the patient.

The appointment of antibacterial drugs as a prophylaxis of pneumonia is not recommended.

Acute cerebrovascular accident is one of the most common severe conditions in the field of neurology. One of the serious comorbidities in stroke is pulmonary edema. The occurrence of a congestive inflammatory process poses a threat to the health of the patient, often ending in the death of the patient.

Causes

swelling after cerebral stroke differ in the complexity of the mechanism for the development of pathology, depending on the level of vascular damage and the clinical symptoms of the disease. The most common causes of education:

age after 60 years;
obesity;
diseases of the heart and blood vessels;
immobility of the body for a long period of time;
long-term use of specific medications.

At the same time, several physiological factors affecting the appearance of pathology are distinguished: insufficiency of blood supply due to changes in the functioning of hemodynamics; disturbance of consciousness; dysregulation of breathing.

Due to volumetric damage to the vessels of the brain, a disorder of the action occurs immune system human body. As a result, the self-purification function of the lungs is destroyed, the cough reflex decreases, and pathogenic microflora is formed. All this provokes the rapid progression of the disease.

Types of post-stroke pneumonia and its symptoms

According to the features of the formation pathological process In the lungs with a stroke, two forms of leakage are distinguished:

Early.
Late.

In the first variant, the disease manifests itself within 2-3 days from the moment of the attack with circulatory disorders. The main culprit of the occurrence is a failure of the regulation of the central nervous system.

The swiftness of the course of the destructive process depends on the zone of formation of the lesion.

The late form of pneumonia appears 15-40 days after the attack. The source is a decrease in blood flow velocity, a failure of the ventilation function in the affected organ.

The inflammatory course passes into a chronic stagnant form with little noticeable symptoms.

Clinical manifestations in the early form, which do not stand out too much due to the negative signs of the brain pathology itself, are usually mild. These include:

increase in body temperature;
shortness of breath, feeling short of breath;
the presence of periodic breathing;
slight cough.

With the development of a late form of pneumonia, the main symptoms are:

increase or decrease in body temperature;
the presence of purulent discharge;
the formation of focal lesions in the affected organ;
changes in the gas and cellular composition of arterial blood.

Foamy compartments with pink tint, gurgling breath, wet whistling rales.

Diagnosis of the disease

A complex is used to determine the presence of pneumonia. diagnostic procedures. Among them: X-ray of the lungs; general analysis blood; troponin test; analysis of the gas composition of arterial blood; general examination of urine; test for the presence of lactic acid;
blood chemistry; hemoximetry; BNP research; electrocardiography;
Ultrasound of the heart, gastrointestinal tract; vein catheterization.

With the help of an x-ray, it is possible to detect significant focal zones of organ damage. In addition, based on the results of the examination of bronchial swabs, the type of pneumonia pathogens, their sensitivity to antibiotics are determined, which will allow the specialist to conduct a course of effective medical therapy.

Treatment and prevention

The treatment of pulmonary edema after a stroke is a rather complex complex process due to the insufficiency or complete absence of the patient's body's personal resources in the fight against the disease. Order necessary action It is aimed at the destruction of a bacterial infection, the restoration of ventilation, and the relief of edema. It is important to start therapy at the first sign of pneumonia.

The treatment course involves the use of:

diuretics;
non-glycoside cardiotonic drugs;
drugs that help thin and remove sputum;
physiotherapy procedures;
breathing exercises.

An important mandatory part of the treatment is the use of antibacterial drugs, with the regulation of medications every 2-3 days.

In addition, a decrease in the risk of developing a destructive process is possible during the prevention of pneumonia and maintenance, based on compliance right conditions maintenance of the patient by the attendants of medical institutions.

Among them: execution hygiene requirements; use of modern tracheostomy tubes.

The difficulty lies in the fact that even under the condition of correctly selected therapeutic therapy, there are no exact guarantees of the formation of secondary pneumonia.

Consequences of inflammation

The admission of errors in treatment can lead to the development of a number of serious complications:

respiratory function disorder, involving the connection of a person to a special
artificial lung ventilation equipment;
inflammation of the urinary tract;
violation of nervous regulation, including the formation of puffiness in various areas of the body,
partial paralysis;
intoxication of the body due to insufficient treatment;
manifestation of leukocytosis.

Often the course of a stroke in combination with pulmonary edema causes the death of the patient.
In general, the prognosis of the consequences of the disease depends on the state of the patient's body, as well as the timeliness of the detection of the inflammatory focus. There is a very high risk of recurrent pneumonia that occurs after cerebral strokes.