Pneumonia with extensive right-sided stroke prognosis. Features of pneumonia as a complication after a stroke

21.06.2019

According to medical data, the main danger for patients suffering from an ischemic stroke or after it is pneumonia. Pneumonia during stroke develops in 30-60% of patients, and in 10-15% of cases it is the cause of death.

Why does pneumonia occur?

The high incidence of pneumonia in such patients is explained by several factors. Patients with severe ischemic stroke experience extensive brain damage. As a result of depressed consciousness, the body's defense mechanisms are disrupted. The brain ceases to control the functioning of internal systems and organs, and ceases to regulate the flow of important biochemical processes. But what is especially destructive with such a lesion is that the body loses its ability to heal itself.

Imbalance of the entire system contributes to weakened immunity and the rapid development of pneumonia during or after a stroke. The impetus for the occurrence of pneumonia is disturbances in the functioning of the respiratory system, in particular:

Failure of swallowing and cough reflexes
Decreased blood microcirculation rate in the bronchi
Stopping the supply of nutrients and oxygen to the respiratory organs
Impaired functioning of the bronchial drainage system
Displacement of normal microflora by pathogenic microflora, which contributes to the development of infection.

The condition of a patient with an ischemic stroke or after it is a forced constant lying position aggravates. As a result, the diaphragm, which helps the lungs pump blood, stops functioning. The fluid that accumulates in the lungs becomes a breeding ground for the development of pathogenic microorganisms and then pneumonia.

What causes 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 ventilation
Overweight patient
Chronic cardiovascular diseases
Respiratory pathologies
Hyperglycemia
Uremia
Long hospital stay
Recumbent 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 a timely manner. The main difficulty is that the symptoms of inflammation in the early stages of a stroke are often mistaken for signs of the underlying disease. Late 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 inflammation that occurs against the background of improvement in the underlying disease. In this case, the picture is clearer, and doctors quickly navigate the diagnosis. In severe strokes, the symptoms of pneumonia are usually more vague and therefore difficult to identify.

How does pneumonia develop?

Patients hospitalized with ischemic stroke most often develop hospital-acquired pneumonia. That is, pneumonia appears a few days after staying 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 the 2-3rd day of hospital stay. The reason for its development is disturbances in the regulation of the central nervous system.

The disease is manifested by elevated temperature, wheezing when breathing, and shortness of breath. Cough is usually absent due to suppression 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 of hospital stay. It is provoked by hypostatic processes that arise as a result of a lying position. Normal blood circulation in the pulmonary circle is disrupted, and 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 manifest themselves in the form of high fever, cough, and 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 drop to 36°), the number of leukocytes in the blood, the development of purulent processes in the trachea, changes in the gas composition of the blood.

Laboratory and x-ray tests are used to make a diagnosis.

Treatment of pneumonia

Main directions of therapy:

Suppression of the inflammatory process
Neutralization of infection
Preventing cerebral edema
Restoring the drainage function of the bronchi
Restoring normal lung function
Boosting immunity
Prevention or treatment of complications.

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

Unfortunately, even with well-equipped laboratories, it is possible to immediately accurately determine the cause of the disease only in 50-60% of cases. The situation is complicated not only by the presence of several pathogens, but also by their existing drug resistance, which has developed in hospital conditions. But to prevent the worsening of the disease and the development of complications, correct and timely prescription of drugs is extremely important.

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

Temperature reduction
Reducing the amount of sputum with pus produced
Decreased leukocytosis
Slowing or stopping the inflammatory process.

Further appointments are made based on the data obtained from previous treatment. The duration of antibiotic use can take from 5 days to one and a half months, depending on the type of pathogen and 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. For this purpose, medications with expectorant and mucolytic effects are prescribed, and physiotherapy is performed: massage, breathing exercises.

In severe cases of the disease, patients are given plasma transfusions 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:

Ensure a flow of fresh air: ventilate the room more often, taking the necessary precautions to prevent the patient from hypothermia.

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

Frequent repositioning: The patient will need to be turned every two hours to promote normal air movement and reduce congestion.

If the patient’s condition allows, he needs to be provided with a semi-lying position (at an angle of 45°) - this 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. Inflating balloons or children's toys helps to restore the functions of the respiratory system. It is recommended to carry out the procedure 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 independently and take a sitting position. The beginning 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. Prevention of the disease, timely diagnosis, and proper treatment are of great importance.

Acute cerebral circulatory disorders are among the most common severe conditions in the field of neurology. One of the serious concomitant diseases of stroke is pulmonary edema. The occurrence of a congestive inflammatory process poses a threat to the patient's health, often ending in the death of the patient.

Causes

Edema after a cerebral stroke is characterized by the complexity of the mechanism of development of the pathology, depending on the level of vascular damage and the clinical symptoms of the disease. The most common causes of formation:

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 are identified that influence the appearance of pathology: insufficiency of blood supply due to changes in the functioning of hemodynamics; disturbance of consciousness; respiratory regulation disorder.

Due to extensive damage to the blood vessels of the brain, the immune system of the human body is disrupted. As a result, the self-cleaning function of the lungs is destroyed, the cough reflex is reduced, and pathogenic microflora is formed. All this provokes the rapid progression of the disease.

Types of post-stroke pneumonia and its signs

According to the peculiarities of the formation of the pathological process in the lungs during a stroke, two forms of progression are distinguished:

Early.
Late.

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

The speed 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 the speed of blood flow, a failure of the ventilation function in the affected organ.

The inflammatory course turns 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 of lack of air;
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;
formation of focal lesions in the affected organ;
changes in the gas and cellular composition of arterial blood.

The main symptoms of pulmonary edema include foamy discharge with a pink tint, gurgling breathing, and moist wheezing.

Diagnosis of the disease

To determine the presence of pneumonia, a set of diagnostic procedures is used. Among them: x-ray of the lungs; general blood analysis; troponin test; arterial blood gas analysis; general urine examination; test for the presence of lactic acid;
blood chemistry; hemoximetry; BNP study; electrocardiography;
Ultrasound of the heart, gastrointestinal tract; vein catheterization.

Using an x-ray, it is possible to detect significant focal areas of organ damage. In addition, based on the results of examining bronchial swabs, the type of pneumonia pathogen and its sensitivity to antibiotics are determined, which will allow the specialist to conduct a course of effective therapeutic therapy.

Treatment and prevention

Treatment of pulmonary edema after a stroke is a rather complex complex process due to the insufficiency or complete absence of the patient’s personal resources in the fight against the disease. The order of necessary actions is aimed at destroying the bacterial infection, restoring ventilation, and relieving edema. It is important to begin therapy at the first signs of pneumonia.

The treatment course involves the use of:

diuretics;
non-glycoside cardiotonic drugs;
medications that help thin and remove mucus;
physiotherapeutic procedures;
breathing exercises.

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

In addition, reducing the risk of developing a destructive process is possible when carrying out the prevention of pneumonia and maintaining it, based on compliance with the correct conditions for keeping the patient by the staff of medical institutions.

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

The difficulty lies in the fact that even if properly selected medical therapy is performed, there are no exact guarantees of the formation of secondary pneumonia.

Consequences of inflammation

Errors in treatment can lead to the development of a number of serious complications:

respiratory function disorder, which involves connecting a person to a special
artificial lung ventilation equipment;
inflammation of the urinary tract;
disturbance of nervous regulation, including the formation of swelling in various areas of the body,
partial paralysis;
intoxication of the body due to insufficient treatment;
manifestation of leukocytosis.

Often 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 condition of the patient’s body, as well as the timeliness of detection of the inflammatory focus. There is a very high risk of repeated pneumonia occurring after cerebral strokes.

Pneumonia after a stroke is one of the most common and dangerous complications. It is pneumonia that most often develops in patients. According to medical statistics, the disease develops immediately in the first post-stroke week in every 4th victim and two to four weeks later in every 8th patient. At the same time, the form of cerebrovascular accident - hemorrhagic or ischemic - has no effect on the occurrence of pneumonia.

Causes of pneumonia after stroke

A stroke causes damage to certain parts of the brain. This can provoke a disruption of blood circulation in the pulmonary circle, as well as the functioning of the drainage system of the lungs.

Against the background of suppression of immune defense, fluid accumulates, separated in the lung tissues and lower respiratory tract, which becomes a suitable environment for the proliferation of pathogenic microflora.

Important! The accelerated development of post-stroke pneumonia is explained by the patient’s low mobility. Prolonged lying on your back and a non-productive (without sputum discharge) cough lead to the accumulation of sputum and the formation of the disease.

Provoking factors are:

the presence of chronic diseases accompanied by decreased immune defense;
elderly age;
pathologies of the oral cavity and nasopharynx;
obesity;
systemic diseases;
prolonged stay on artificial ventilation (longer than 6 days);
long-term immobility;
problems with the functioning of the respiratory system or pulmonary circulation.

The causes of bacterial pneumonia include:

infection of the victim during the period of invasive resuscitation measures;
poor quality disinfection of air conditioners;
poor patient care.

Appearance mechanism

Paralysis of the respiratory muscles makes it difficult to remove pulmonary sputum. As a result of the development of congestion, the patient develops pneumonia.

Prolonged stay in a horizontal position and low mobility cause stagnation of blood in the pulmonary circulation (PCC) and the release of blood plasma beyond the blood vessels. Filling of the pulmonary alveoli with liquid contents (exudate) disrupts the normal passage of gas exchange processes, and the presence of pathogenic microflora initiates the development of local inflammation.

While the patient is unconscious, it is possible that vomit or gastric juice may enter the lungs. In this case, a person develops an aspiration form of pneumonia, that is, resulting from the penetration of liquids or foreign bodies into the lungs.

Symptoms

It is very difficult to recognize the development of one- or two-sided pneumonia that has formed during the first three to seven days after a stroke. This is due to a significant impairment of the patient’s general condition. The clinical picture of the disease is very blurred, which makes diagnosis difficult.

Important! The development of early pneumonia is caused by disturbances in the respiratory process as a result of a malfunction of the respiratory center.

But there are certain symptoms. This:

a slight rise in general body temperature or a drop below 36 degrees;
hoarse breathing;
modifications in lung tissues identified during radiography;
increase in the number of blood leukocytes.

Cough, which is one of the probable signs of pneumonia, most often does not develop. Sometimes it is present, but almost always ineffective (no sputum discharge occurs).

Late pneumonia, which forms 14–30 days after a stroke, develops against the background of stagnation of blood in the pulmonary circulation. The symptoms of the disease in this case are more pronounced.

The patient has:

increase in body temperature to significant levels;
chills;
cough;
the content of purulent impurities in the separated sputum;
a significant increase in the number of blood leukocytes;
chest pain that gets worse with breathing;
dyspnea.

If the development of pneumonia is suspected, sputum is collected. The study of biomaterial helps to identify the causative agent of the pathology. If necessary, a chest x-ray is prescribed.

Important! Diagnosis of pneumonia in the early stages allows treatment to begin and improves the prognosis of the outcome of the disease.

Treatment

Therapeutic tactics depend on many factors. This:

patient's age;
causes of the disease;
duration;
type of pathogen;
severity of general condition;
severity of neurological disorders;
accompanying illnesses.

Treatment of pneumonia after a stroke includes the following:

taking drugs from the group of antibiotics;
supporting the patient's respiratory function;
prevention of the development of edema of brain and lung tissues;
stimulation of the drainage function of the bronchi;
symptomatic treatment;
taking detoxifiers, antioxidants, immunomodulators;
physical therapy, massage, physiotherapeutic procedures.

Important! To start taking antibiotics, you do not need to wait for the results of a bacteriological examination of bronchial secretions.

Immediately after confirmation of the diagnosis, the patient is prescribed antibiotics. If necessary, adjustments can be made to the selected drug and its dosage regimen after receiving the results of a bacteriological analysis of pulmonary discharge.

The choice of antibiotic is influenced by the period of development of pneumonia, since the causative agents of the disease are different in each case:

treatment of early onset pneumonia is carried out with the help of Ceftriaxone and Ampicillin;
therapy for late pneumonia involves an integrated approach - the patient simultaneously receives several drugs;
To eliminate the aspiration format of pneumonia, Metronidazole and Clindamycin are used.

To improve respiratory function, the patient is prescribed oxygen therapy. If necessary, the person is connected to a ventilator. In both cases, the blood gas composition is normalized, which has a beneficial effect on the course of metabolic processes.

To stimulate drainage functions, drugs from the groups of bronchodilators, mucolytics and bronchodilators are prescribed, in particular, Eufillin, Bromhexine, Acetylcysteine. But treatment is carried out only if the patient is breathing on his own and is not in a coma. In the case of forced ventilation, the bronchi are cleaned of accumulated mucus in an automatic mode.

The patient must be prescribed immunomodulators, immunoglobulins, as well as the administration of specially prepared plasma.

The duration of therapy for pneumonia in the post-stroke period is determined by the patient’s doctor or resuscitator if the patient is in a hospital. The criteria are the dynamics of the patient’s condition, the results of laboratory tests and instrumental techniques.

In the absence of treatment for pneumonia after a stroke that develops in bedridden patients, the disease ends in the death of the patient. Weakened immune defenses are unable to destroy the infection.

With delayed therapy or incorrectly chosen tactics, a person can develop serious complications. The consequences of the disease may include:

formation of lung abscess;
gangrenous lesions of lung tissue;
exudative form of pleurisy - damage to the pleura, accompanied by filling of its cavity with liquids of various origins;
empyema of the lungs is a secondary pathology characterized by filling the pleural cavity with purulent masses;
pneumosclerosis - pathology is accompanied by the replacement of lung tissues with connective tissues;
infectious-toxic shock;
multiple organ failure is a pathological condition accompanied by disruption/complete absence of functionality of more than two organs or body systems.

Prevention of pneumonia in a bedridden patient

Treatment of inflammation against the background of a major stroke is quite difficult. That is why, after transporting the victim to a medical facility, a number of measures are carried out aimed at preventing the development of the disease. These include:

raising the patient's upper body - the bed in the head area always remains elevated;
turning the patient's body over several times during the day and night;
daily sanitation of the nasopharynx;
physiotherapy;
compliance with the rules of asepsis and antiseptics;
the use of individual tracheostomies when connecting the victim to a ventilator;
performing chest massage;
early activation - performing passive movements is recommended from the second day;
breathing exercise.

The appearance of primary symptoms of the disease is a reason for urgent consultation with a doctor, since lost time and late started therapy significantly worsen the prognosis.

Forecast

Predicting the outcome of post-stroke pneumonia is difficult. This is due to many factors. The leading ones are preventive measures, timely diagnosis and therapy that is adequate to the patient’s current condition. Effectively administered treatment significantly reduces the risk of death, increasing the patient's chances of a full recovery.

The patient’s age also plays an equally important role in prognosis: the older the patient, the fewer chances doctors give. According to statistics, out of 10 elderly patients who have had a stroke, 1 patient dies.

Pneumonia that develops in the post-stroke period requires close attention because it threatens the patient’s life. Delayed diagnosis of pathology and lack of drug support can cause death.

Stroke is primarily dangerous due to 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.

Thus, pneumonia after a stroke occurs in 35 to 50% of all cases of brain damage. This condition threatens the patient’s life and in 15 out of a hundred patients ends in death.

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 lung inflammation during stroke

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

In both cases, violations lead to the need to be connected to a ventilator for the entire duration of drug therapy.

What is the danger of pneumonia during a stroke?

Treatment of congestive pneumonia in bedridden patients due to 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.

In addition, it is quite easy to contract pneumonia even in a hospital. For the development of disorders, it is enough that two factors coincide: lack of blood supply and the causative agent of the inflammatory process: staphylococcus or gonococcus.

Avoiding pneumonia in the post-stroke state is problematic, since the main consequence of a hemorrhagic or ischemic attack is the development of an acute lack of blood supply.

When the first signs of pneumonia are detected in a person who has suffered a stroke, mandatory drug therapy is prescribed.

In the absence of adequate therapeutic measures, the following complications develop:

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

In-hospital bilateral pneumonia is one of the most serious disorders. Inflammation develops in two lungs at the same time. The remaining sections cannot provide enough oxygen, which leads to loss of consciousness and.

How to prevent post-stroke pneumonia

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

Reducing the pathogenic factor - preventing pneumonia largely depends on the efforts of the medical and hospital staff to provide the necessary conditions to reduce the unfavorable flora of the upper respiratory tract. Daily sanitation and physiotherapy are carried out.
Compliance with hygiene rules - the development of pneumonia during treatment for a stroke is often a consequence of neglecting the prescribed rules of treatment measures: asepsis and antiseptics.
The use of a breathing tube - a tracheostomy, through which a connection to a ventilator is made, can provoke the onset of inflammation. Protection against damage is provided by modern tracheostomy tubes.

The effectiveness of using antibiotics for prophylactic purposes is, to put it mildly, questionable. Drugs in this group are used exclusively to combat infectious or bacterial inflammation that has already begun.

How can pneumonia be cured after a stroke?

Pneumonia, as a complication after a stroke in the elderly, is difficult to treat due to the almost complete lack of the body’s own reserves to fight the disease. The course of therapy has to be adjusted several times. Even competent treatment does not guarantee that secondary pneumonia will not develop over time.

Treatment measures are aimed at achieving the following goals:

Relief of brain swelling.
Fighting congestion in the lungs.

To achieve the goals, they use: diuretics, cardiotonics, mucolytics, physiotherapy and breathing exercises. A course of antibacterial therapy is required, with medication adjustments every 72 hours.

The prognosis of complications of pneumonia is influenced by the general condition of the patient and how timely the inflammatory process was identified. In every case of stroke, there is a possibility of developing apoplexy.

In almost 15% of them, pneumonia is fatal.

Reasons for the development of complications

The high incidence of post-stroke pneumonia is directly related to the fact that in patients severe forms of cerebral circulatory disorders lead to profound depression of consciousness and breathing, swallowing and cough reflexes. The situation is also aggravated by hemodynamic changes in the blood circulation of the lung tissue, weakened immunity, and a malfunction in the bronchial drainage system. All this contributes to an imbalance in the functioning of normal microflora and its displacement by pathogenic ones.

The vast majority of patients, when admitted to the intensive care unit or intensive care unit, receive so-called hospital-acquired pneumonia, which develops in the first two days from the onset of the acute period of cerebrovascular accident.

Factors that provoke this dangerous complication include:

Age 60 years and older.
Excess body weight.
The patient has been on mechanical ventilation for more than a week.
Prolonged static position, adynamia.
History of chronic cardiovascular and pulmonary pathology, uremia and hyperglycemia.

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

Mechanism of development of complications

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

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

At a later stage (period 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 come out.

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), and the initial condition of the patient. The rate of development of complications is also influenced by the location of the lesion in the brain.

Clinical manifestations

Diagnosing early pneumonia after a stroke is quite difficult.

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

Moderate fever.
Respiratory rhythm disturbance.
Lack of cough reflex.

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

Increased content of leukocytes in the blood.
Purulent discharge from the trachea.
Pathological changes on x-rays.
Wheezing, gurgling or bubbling sounds during breathing.

Late pneumonia during stroke occurs with more severe symptoms:

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

The radiograph shows reduced transparency of the pulmonary field with delicate cloud-like infiltrates of small diameter (up to 3 cm).

If a specialist diagnoses inflammation at the initial stage, promptly started therapy gives a positive prognosis.

If a complication is suspected, tomography and plain radiography of the chest organs are prescribed. To identify pathogenic microflora, sputum is collected from the patient.

Treatment program

Drug therapy must solve several important problems:

Stop hypoxia as soon as possible.
Prevent the development of pulmonary edema during stroke.
Suppress and neutralize the infectious agent.
Restore the drainage ability of the bronchi.
Resume normal lung function.
Increase immune defense.

Drug therapy with broad-spectrum antibacterial drugs is prescribed immediately after confirmation of the diagnosis and lasts from 10 to 40 days. The program includes antibiotics of the cephalosporin group of I–III generations, which are combined with aminoglycosides and fluoroquinolones in the following combinations:

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

Treatment includes:

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

The following are prescribed as auxiliary procedures to improve expectoration:

Oxygen therapy.
Manual or vibration massage course.
Breathing exercises.
Physiotherapy with bronchodilators.

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

Temperature reduced to normal values.
Reducing the amount of purulent sputum produced.
Reduced leukocytosis in the blood.

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

Prevention

Pneumonia can be avoided if the patient is provided with proper care and a number of important procedures are performed.

To operate the diaphragm and eliminate stagnation, you need:

Regularly turn the patient over from the right side to the left 6-8 times a day, sit on the bed, and lie on his stomach.
Thorough cleansing of the oral cavity: teeth, tongue, gums from food debris.
Daily massage (3 to 5 times) of the upper third of the chest
Physiotherapy.
Inflating balloons, plastic bags, blowing air through a tube inserted into a container of water.
At home, alternating jars and mustard plasters is recommended.

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

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

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

Untreated pneumonia after a stroke is always fatal. If not treated in a timely manner, the disease can be complicated by an abscess, gangrene, exudative pleurisy or empyema.

Causes of pneumonia after 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 cerebral 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 suffering impaired blood circulation in the brain.

These factors include:

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

The appearance of pneumonia after a stroke is influenced by the following reasons:

The causative agents of this disease most often are:

Klebsiella;
Escherichia coli and Pseudomonas aeruginosa;
Staphylococcus aureus.

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

Aspiration pneumonia. This condition occurs as a result of small food components entering the upper respiratory tract, which leads to the cessation of the functioning of the affected part of the lung tissue. The microorganisms found in them cause inflammation. The main symptoms of this type of pneumonia resemble intoxication, which is characterized by a severe cough. The worst thing is when pieces of food that enter the respiratory system block the area of large bronchi. As a result, it is very difficult for the patient to cough, and after a few days pneumonia occurs with a high fever.
Congestive pneumonia. This type of disease is mainly diagnosed in bedridden patients, since constant stay in this position causes serious circulatory problems in the lungs. As a result, ventilation of the lungs worsens and sputum removal becomes more difficult.

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

Symptoms and diagnosis of the disease

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

However, it is still possible to identify several symptoms of an early form of pneumonia:

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

The late and advanced form of pneumonia develops within 2-6 weeks after the onset of a stroke and if this complication is not treated, it can be fatal.

The main symptoms of this stage:

chills and increased body temperature 38-39.5 degrees;
purulent sputum;
cough may occur;
a significant increase in the level of leukocytes in the blood.

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

If it is possible to promptly determine the presence of pneumonia at the initial stage of its development, then timely treatment begins allows us to hope for positive results.

The danger of pneumonia after a stroke

It is worth knowing that it is quite easy to catch pneumonia in the hospital. For this, it is enough for the human body to be infected by staphylococcus, and a stroke to develop.

In this case, it can be difficult to avoid the appearance of pneumonia, since circulatory impairment occurs as a result of this disease.

In the absence of 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 functioning of the heart muscle.
Loss of respiratory function - in order to cope with the situation, the patient requires installation of a device for ventilation, which complicates the rehabilitation of the patient, because 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 drug treatment. In addition, the patient is provided with additional techniques that increase the process of expectoration of exfoliated sputum.

These events include:

breathing exercises;
special massage performed manually;
turn the patient over every 3-4 hours.

Preventive actions

Proper and timely care for a stroke victim can reduce the risk of developing pneumonia.

the headboard should be raised at an angle of 30 degrees;
alternate turns from one side to the other at least 7 times a day;
high-quality purification 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;
carrying out high-quality hygiene;
care of medical supplies;
ventilation of the hospital room, which will reduce the number of germs in the air.

Immediately after being discharged, he should begin physical exercises that will improve his cough and quickly remove phlegm. Correctly following your doctor’s advice will help you quickly restore your 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, occurring in half of all patients who have suffered a severe cerebrovascular accident. The success of therapy depends on a timely diagnosis and accurate determination of the cause of the pathology. The inflammatory process in the lungs develops against the background of 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 during stroke occurs in bedridden patients due to impaired breathing quality. Loss of quality control of inhalation and exhalation leads to congestion in the lungs; in addition, a weakened body is unable to fight many bacteria and microorganisms that can provoke pneumonia.

It can be:

enterobacter and klebsiella;
coli coli or Pseudomonas aeruginosa;
Staphylococcus aureus.

Exudate accumulated in the alveoli, difficult sputum discharge, and the release of white and red blood cells lead to disruption of gas exchange, and being immobile for a long time causes the development of stagnation 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 the moment 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 the lung tissue. Self-regulation and self-defense of the body of a patient who has suffered an apoplexy is impaired.

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

Another type of pneumonia is congestive. It manifests itself in patients who have lost the ability to move and remain in one (lying, horizontal) position for a long time. 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 ventilation of the lungs, which also contributes to the occurrence of pneumonia, but the most significant reasons are changes in blood flow and impaired functionality of the muscles, including those that support breathing.

Diagnosis and most striking symptoms

Suspicion of pneumonia after a stroke arises in cases where, a few days after an apoplexy:

the temperature rises slightly and stays there without falling;
breathing becomes shallow, frequent and difficult;
pronounced wheezing and bubbling are heard both on inhalation and exhalation;
inhalation is particularly difficult;
shortness of breath is clearly audible in an immobile patient;
a dry, tearing cough turns into a wet cough after a couple of days, and streaks of blood are visible in the sputum;
despite the abundance 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 an increase, but also by a decrease in body temperature to 35° due to impaired 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 white blood cells and the erythrocyte sedimentation rate. The white blood cell count may be markedly reduced due to a reaction to brain damage.
X-ray, which can be used to detect changes in lung tissue. Such lesions are not always immediately visible on photographs, so the examination is carried out several times and in several projections.
Blood biochemistry shows disruptions in gas and acid-base balance. With this test, an inflammatory protein is detected in the blood.
Sputum culture.
Bronchoscopy.
CT scan.

Therapeutic measures and prevention

Pneumonia that occurs after a stroke requires a special approach. Considering the serious condition of the 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 patient’s age, the presence of concomitant diseases and the severity of disorders of the nervous system.

For effective treatment, the doctor may prescribe:

antibiotics;
medications to maintain respiratory function;
means to prevent the development of cerebral edema;
medications that improve the drainage function of the bronchi.

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

Along with drug treatment, it is also of great importance for patients to perform therapeutic exercises, massage sessions, and physiotherapeutic procedures. As for prescribing antibacterial drugs, there is no need to wait for the results of a sputum test. Stasis after the doctor has diagnosed pneumonia after a stroke, patients are prescribed a course of antibiotic therapy.

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

The head end of the bed should be raised.
The patient's position must be changed at least 4 times a day.
At least twice (morning and evening) during water procedures and rubbing, 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, why is it dangerous and how is it treated?

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 lung inflammation during stroke

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

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

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

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

The accumulation of viscous and thick fluid 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 be connected to a ventilator for the entire duration of drug therapy.

What is the danger of pneumonia during a stroke?

Complete or partial loss of respiratory function requires connection to a ventilator, making the patient’s rehabilitation difficult, since recovery requires a normal supply of oxygen to the body.

Signs of intoxication from congestive pneumonia do not have pronounced manifestations and are not determined using clinical blood tests. Leukocytosis is either completely absent or observed to a minor extent.

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

How to prevent post-stroke pneumonia

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

How can pneumonia be cured after a stroke?

Relief of brain swelling.

To achieve the goals, they use: diuretics, cardiotonics, mucolytics, physiotherapy and breathing exercises. A course of antibacterial therapy is required, with medication adjustments every 72 hours.

Features of pneumonia as a complication after a stroke

Pneumonia during stroke occupies a leading place in the list of causes of death in patients who have suffered a cerebrovascular accident. Immediately after a stroke, every fourth patient, and within a month, every eighth patient begins to have pneumonia. What are the causes, symptoms, prognosis and treatment for this diagnosis?

Reasons for development

As a result of a stroke, being left without oxygen for a while, certain areas of the brain are affected. Because of this, dysfunction of the blood flow in the pulmonary circle, dysfunction of the diaphragm and lung drainage system can occur.

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

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

Patients at risk are:

people with a reduced level of immunity (kidney disease, liver disease, heart disease, etc.);
those who have crossed the age threshold of 65 years;
in the presence of chronic or acute diseases of the oral cavity, nasopharynx;
having excess weight;
in the presence of systemic diseases;
if mechanical ventilation was carried out for longer 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 the blood flow in the pulmonary circulation.

These are not all the causes 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 patient care.

But even if any of the above factors are present, 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 for the course of the disease.

Symptoms and diagnosis

It is almost impossible to notice manifestations of pneumonia in the early form (occurring 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:

slight increase in general body temperature;
wheezing and nonspecific sounds (gurgling, bubbling) when breathing;
obvious changes in lung tissue on x-ray;
In blood tests, as a rule, an increase in the level of leukocytes is observed.

In most cases, cough is absent or mild and ineffective.

But in the late form of pneumonia (the onset occurs later), the symptoms are more pronounced:

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

At the slightest suspicion 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 traditional plain chest x-ray).

If it is possible to notice signs of pneumonia in the early stages, then timely treatment begins gives hope for a positive prognosis.

If the use of x-rays is impossible due to the severe course of the underlying disease, then the diagnosis is established based on general symptoms, as well as available laboratory data. After confirming the diagnosis and prescribing treatment, blood tests and a number of other general studies are collected daily to monitor the dynamics of the disease.

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Treatment

Prescription of drug therapy should occur immediately after the diagnosis is confirmed. At the beginning of treatment, broad-spectrum antibiotics are used, and after the pathogen and its resistance to drugs are accurately determined, 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 prescribing monotherapy (that is, just one drug). Usually, expectorants, sputum thinners, diuretics, as well as drugs that stimulate the cough center are added to the main drug (if the patient’s condition allows it).

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

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In severe cases, with a large volume 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 performed several times until the condition improves.

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

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

special vibration massage using manual or hardware method;
breathing exercises;
change the patient's position 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 there is for a positive outcome. Thus, according to statistics, every 10 cases of pneumonia after a stroke in elderly people ends in death.

How to avoid pneumonia?

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

rollovers alternately on each side 5-7 times a day;
sanitation of the oral cavity, as well as brushing teeth after eating;
massage the upper back to induce coughing and effective expectoration;
setting the headboard at an angle;
fairly frequent ventilation of the room 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.

Physical exercise should begin immediately after the doctor’s permission, so the cough will become more productive and blood circulation in the pulmonary circulation will significantly improve. This approach is one of the most effective methods of preventing and eliminating congestion after pneumonia.

Do you think that it is impossible to restore body functions after a stroke? Judging by the fact that you are reading these lines now, victory in the fight against the consequences of the disease is not on your side. It should be noted that the sooner rehabilitation begins, the greater the chance of a full recovery. And the likelihood of returning to an active life increases many times over if you recover under the supervision of specialists at a rehabilitation center.

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Stroke and pneumonia – it can’t be worse

A stroke in itself is a serious disease that can easily make a person permanently disabled. What can we say when after one “blow” to health comes a second, no less serious one – pneumonia. The most common development is the congestive version of this disease, which is a complication of a previous stroke.

According to statistics, the incidence of pneumonia after a stroke ranges from 35 to 50%. In approximately 15% of complications, pneumonia causes death. It would seem that a person survived after one illness, but could not cope with the second. Any pneumonia during a stroke has its own reasons; it makes sense to understand 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 complications and prevent their occurrence in the first place.

Elderly and senile people often experience pneumonia after a stroke. Their lung drainage function is normally impaired, and after a stroke there is virtually no sputum production, especially if the disease is severe. The risk of pneumonia increases significantly after a person turns 65 years old.

Excess weight in itself is a predisposing factor to 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 suffered from chronic forms of heart and lung disease before the stroke.

After a stroke, a person can often be in a coma, this contributes to the development of congestion in the lungs. The cause of this condition is a violation or complete absence of sputum outflow. A similar condition occurs during prolonged artificial ventilation, which is carried out in the absence of spontaneous breathing. Often a week is enough for pneumonia to occur. Sometimes even a conscious patient remains 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 for the development of the disease. They consist of:

in a depressed consciousness for a certain time;
central respiratory dysfunction;
lack of active movements;
impaired blood supply to the lungs.

The degree of damage depends on the massiveness of the brain tissue damage, as well as the location where the hemorrhage or blockage of the vessel occurred. As a result, the function of draining mucus from the lungs is impaired in some patients. The cough reflex or the urge to cough is reduced or absent; it is this that is protective and promotes the discharge of sputum. Microorganisms are replaced by more aggressive ones that can cause disease. Then it’s just a matter of time and the disease does not keep itself waiting long, the inflammatory process develops rapidly.

Other factors

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

Symptoms of the disease

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

Some symptoms may be noticeable:

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

Features of aspiration pneumonia

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

With aspiration pneumonia, the manifestations resemble intoxication or poisoning. Initially, a cough is noticed, which is painful in nature. The hilar variant of aspiration pneumonia is difficult to diagnose. A high temperature develops and coughing becomes painful. A dangerous situation becomes when a large bronchial tube is blocked by pieces of food.

Symptoms of late variants

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

rapidly developing fever, numbers above 38 degrees;
in a blood test, the increased number of leukocytes is of interest;
there is pus in the sputum or discharge from the trachea;
The X-ray image clearly shows pathological changes in the lung tissue.

Definitive diagnosis

In addition to symptoms, there are some standards for instrumental diagnosis of the problem. Initially, it is worth listening to the chest using a phonendoscope; if pneumonia is suspected, then an X-ray examination of the lungs is prescribed. In addition to stagnant phenomena, the most intense shading center will be clearly visible in the image.

Sputum or bronchial washings are subject to examination. This analysis will allow us to determine the type of pathogen, after which its individual sensitivity to antibacterial drugs is carried out. This analysis will subsequently allow the doctor to prescribe effective treatment.

Treatment

In case of pneumonia, which could be complicated by a stroke, measures are aimed at eliminating hypoxia as quickly as possible. The tissues must receive more oxygen, this is done through artificial ventilation or the use of oxygen pillows. It is necessary to pay attention that pulmonary edema is often associated, which is why prevention of this condition is carried out.

At the same time, treatment of the underlying disease is carried out, which is prescribed by a neurologist. After establishing the type of pathogen and its sensitivity to antibiotics, appropriate drugs are used. Before 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.

Diuretics are mandatory; they help reduce swelling and prevent pulmonary edema. Cardiac medications and expectorants are indicated. If there are problems with sputum discharge as a result of its viscosity, the doctor may prescribe medications to thin it.

Additionally

After the person’s condition has been stabilized due to a stroke, physiotherapy is recommended. Electrophoresis with potassium iodide is excellent for removing mucus. Exercise therapy under the guidance of an instructor is also indicated; it is mainly aimed at restoring breathing.

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

Prevent pneumonia

When there is an understanding of the mechanism of disease development, the development of the disease can be prevented. Based on this, certain preventive measures have been 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 and the quality of their duties. In the intensive care unit, in addition to the treatment of instruments and surfaces, sanitation of the bronchial tree is mandatory.
It is necessary to carefully observe the rules of hygiene, including personal hygiene. Medical workers should adhere to the rules of asepsis and antisepsis.
The tube that is used for ventilation must be for individual use and must be processed and disposed of after use. The same applies to other instruments that may come into contact with the human respiratory system.

Prevention

There are some things you can do to help prevent pneumonia from developing after a person has had a stroke. Some moments will require effort from the caregiver and staff, but then they will fully justify themselves.

Initially, it is worth ensuring a constant flow 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 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 is changed every two hours. If the patient is in a normal condition, he is given a semi-lying position at an angle of 45 degrees.

Additionally, breathing exercises are indicated, which are carried out no earlier than an hour and a half after the last meal. It is useful to inflate children's balloons. Additionally, a special massage is provided for about three sessions throughout the day.

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

What to do if you have pneumonia after a stroke?

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

Clinical picture

Factors contributing to the development of pneumonia after a stroke:

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

Causes of the disease:

Experts identify the following symptoms of the disease:

GM damage;
violation of the drainage functions of the lungs;
cough.

Staphylococcus aureus is the causative agent of pneumonia.

Frequent causative agents of the disease are:

Staphylococcus aureus;
coli;
Klebsiella;
Pseudomonas aeruginosa.

It is recommended to ask your doctor what to do if the first signs of pneumonia appear after a stroke. Treatment is prescribed depending on the type of pneumonia:

The disease is diagnosed 2-3 days after hospitalization. The patient's central nervous system is dysregulated and swelling appears in the lungs. The prognosis depends on the location of the lesion. 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 manifest themselves in the form of high body temperature, cough pathology, and wheezing. How long an adult’s temperature lasts depends on the severity of the pneumonia. Main clinical and laboratory parameters:

To identify focal changes, an X-ray examination of the lungs is performed. To make an accurate diagnosis, specialists 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 diagnosis, antibacterial agents (from various groups) are used. After 5 days, the course of therapy is adjusted taking into account the body’s reaction, the type of pathogen identified, and 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, and expectorants. It is recommended to carry out physical therapy and do breathing exercises. If the patient has urinary incontinence, bladder catheterization is performed. Prevention of inflammation of this system consists of strict adherence to the rules of personal hygiene, rinsing the bladder, and taking a bacteriological urine test. In men, the catheter is fixed to the abdomen. The inflammatory process is treated with antibiotics.

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

In severe cases of the disease, the covering tissues may become dead. If this process penetrates deeply, the wound becomes infected and the body becomes infected. Prevention of bedsores involves regularly changing body position (once every 2 hours). The skin is treated with warm camphor alcohol. If pneumonia disrupts the functioning of the large intestine, you will need to follow a diet. The diet includes fiber and fermented milk 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 bedridden patient:

To prevent pneumonia after a stroke, it is recommended:

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

Antibacterial drugs should not be taken to prevent pneumonia.

Pneumonia during and after stroke

Why does pneumonia occur?

Failure of swallowing and cough reflexes
Decreased blood microcirculation rate in the bronchi
Stopping the supply of nutrients and oxygen to the respiratory organs
Impaired functioning of the bronchial drainage system
Displacement of normal microflora by pathogenic microflora, which contributes to the development of infection.

What causes 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 ventilation
Overweight patient
Chronic cardiovascular diseases
Respiratory pathologies
Hyperglycemia
Uremia
Long hospital stay
Recumbent state
Taking certain medications.

Difficulties in diagnosis

How does pneumonia develop?

Early pneumonia develops on the 2-3rd day of hospital stay. The reason for its development is disturbances in the regulation of the central nervous system.

Laboratory and x-ray tests are used to make a diagnosis.

Treatment of pneumonia

Main directions of therapy:

Suppression of the inflammatory process
Neutralization of infection
Preventing cerebral edema
Restoring the drainage function of the bronchi
Restoring normal lung function
Boosting immunity
Prevention or treatment of complications.

Unfortunately, even with well-equipped laboratories, it is possible to immediately accurately 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 existing drug resistance, which has developed in hospital conditions. But to prevent the worsening of the disease and the development of complications, correct and timely prescription of drugs is extremely important.

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

Temperature reduction
Reducing the amount of sputum with pus produced
Decreased leukocytosis
Slowing or stopping the inflammatory process.

In severe cases of the disease, patients are given plasma transfusions 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:

Ensure a flow of fresh air: ventilate the room more often, taking the necessary precautions to prevent the patient from hypothermia.

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

Frequent repositioning: The patient will need to be turned every two hours to promote normal air movement and reduce congestion.

If the patient’s condition allows, he needs to be provided with a semi-lying position (at an angle of 45°) - this 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.

Banks or mustard plasters.

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