Pneumonia after a stroke is one of the most common and dangerous complications. It is pneumonia that develops in patients most often. According to medical statistics, the disease is formed directly in the first post-stroke week in every 4th victim and two to four weeks later - in every 8th patient. In this case, the form of cerebral circulation disorder - hemorrhagic or ischemic - does not affect the occurrence of pneumonia.

Reasons for the development of pneumonia after a stroke

A stroke causes damage to certain parts of the brain. This can provoke a violation 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 the immune defense, there is an accumulation of fluid secreted in the lung tissues, lower respiratory tract, which becomes a suitable environment for the reproduction of pathogenic microflora.

Important! The accelerated development of post-stroke pneumonia is explained by the patient's low mobility. Prolonged lying on the back and unproductive (without sputum discharge) coughing lead to the accumulation of sputum and the formation of the disease.

The provoking factors are:

• the presence of chronic diseases, accompanied by a decrease in immune defense;
• elderly age;
• pathology of the oral cavity and nasopharynx;
• obesity;
• systemic diseases;
• prolonged stay on artificial lung ventilation (more than 6 days);
• long-term immobility;
• problems with the respiratory system or the pulmonary circulation.

The reason for the development of a bacterial form of pneumonia is:

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

Mechanism of appearance

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

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

During the period when 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, i.e., arising as a result of the penetration of fluids or foreign bodies into the lungs.

Symptoms

It is very difficult to recognize the development of unilateral or bilateral pneumonia, which formed during the first three to seven days after the stroke. This is due to a significant violation of the general condition of the patient. The clinical picture of the disease is highly blurred, which complicates the diagnosis.

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

But there are certain symptoms. It:

• a slight rise in the general body temperature or its drop below 36 degrees;
• hoarse breathing;
• changes in the lung tissue, identified during the passage of radiography;
• an increase in the number of blood leukocytes.

Cough, which is one of the likely signs of pneumonia, usually does not develop. It is sometimes present, but almost always ineffective (sputum does not pass).

Late pneumonia, which develops on the 14-30th day after the stroke, develops against the background of stagnation of blood in the pulmonary circulation. The symptomatology of the disease in this case is more pronounced.

The patient has:

• an increase in body temperature to significant indicators;
• chills;
• cough;
• the content of purulent impurities in the separating sputum;
• a significant increase in the number of blood leukocytes;
• pain in the chest, aggravated by breathing;
• dyspnea.

If there is a suspicion of developing pneumonia, sputum is taken. The study of biomaterial helps to identify the causative agent of the pathology. If necessary, a chest X-ray is prescribed.

Important! Early diagnosis of pneumonia allows treatment to be initiated and improves the prognosis of the disease outcome.

Treatment

Therapeutic tactics depend on many factors. It:

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

Treatment for pneumonia after stroke includes the following points:

• taking drugs from the antibiotic group;
• support of the patient's respiratory function;
• prevention of the development of edema of the tissues of the brain and lungs;
• stimulation of the drainage function of the bronchi;
• symptomatic treatment;
• taking detoxifying agents, antioxidants, immunomodulators;
• physiotherapy exercises, massage, physiotherapy procedures.

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

Immediately after confirming the diagnosis, the patient is prescribed antibiotics. If necessary, the selected drug and the scheme of its administration can be adjusted after receiving the results of the bacteriological analysis of the pulmonary separable.

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:

• early onset pneumonia is treated with Ceftriaxone and Ampicillin;
• therapy of late pneumonia involves an integrated approach - the patient receives several drugs at the same time;
• to eliminate the aspiration format of pneumonia, Metronidazole and Clindamycin are used.

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

To stimulate drainage functions, drugs from the groups of bronchodilators, mucolytics and bronchodilators are prescribed, in particular, "Euphyllin", "Bromhexin", "Acetylcysteine". But treatment is carried out only if the patient breathes on his own and is not in a coma. In the case of forced ventilation, cleaning the bronchi from accumulated sputum is performed automatically.

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

The duration of therapy for pneumonia in the post-stroke period is determined by the patient's leading doctor or the resuscitator, if the patient is in the 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 eradicate the infection.

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

• the formation of an abscess of the lungs;
• gangrenous lesion of the lung tissue;
• exudative form of pleurisy - damage to the pleura, accompanied by the filling of its cavity with fluids of various origins;
• empyema of the lungs is a secondary pathology characterized by the filling of 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 a violation / complete lack of functionality of more than two organs or systems of the body.

Prevention of pneumonia in a bedridden patient

Therapy of inflammation against the background of an extensive stroke that has occurred is rather 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:

• lifting the patient's upper body - the bed in the head area always remains raised;
• turning the patient's body 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 tracheostomy when connecting the victim to the ventilator;
• performing a chest massage;
• early activation - the implementation of passive movements is recommended from the second day;
• breathing exercise.

The appearance of the 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, the timeliness of the diagnosis and the implementation of therapy adequate to the current state of the patient. Effective treatment significantly reduces the risk of death, increasing the patient's chances of full recovery.

The age of the patient also plays an equally important role in forecasting: the older the patient is, the less chance the doctors give. According to statistics, out of 10 elderly patients who have suffered a stroke, 1 patient dies.

Pneumonia that develops in the post-stroke period requires close attention, since it threatens the patient's life. Late diagnosis of pathology and lack of drug support can be fatal.

In almost 15% of them, pneumonia is fatal.

The reasons for the development of complications

The high rate of post-stroke pneumonia is directly related to the fact that in patients, severe forms of cerebrovascular accident lead to deep depression of consciousness and respiration, swallowing and cough reflexes. The situation is aggravated by hemodynamic changes in the blood circulation of the lung tissue, 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 to pathogenic.

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

The factors provoking this dangerous complication include:

1. Age 60 and over.
2. Overweight.
3. Stay of the patient for more than a week on artificial ventilation.
4. Prolonged static position, weakness.
5. 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.

The 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, fibrobronchoscopy) or lack of proper care. In bedridden patients, after a stroke, particles of food or vomit enter the upper respiratory tract. A disturbed swallowing act and the absence of a cough reflex give an 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 (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, 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 rate of development of complications is also affected by the localization of the focus in the brain.

Clinical manifestations

Diagnosing early pneumonia after a stroke is difficult.

Its symptomatology is nonspecific, in terms of signs it is similar to the primary pathology:

• Moderate fever.
• Respiratory rhythm disorder.
• Lack of cough reflex.

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

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

Late pneumonia with stroke passes with more pronounced symptoms:

• Fever up to 39-40 ° C.
• Frequent attacks of chills.
• Discharge of purulent sputum.
• Moist wheezing.

On the roentgenogram, the transparency of the pulmonary field is reduced with delicate cloudy infiltrates of small diameter (up to 3 cm).

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

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

Treatment program

Drug therapy must solve several important problems:

• Stop hypoxia as soon as possible.
• Prevent the development of pulmonary edema in stroke.
• Suppress and neutralize the infectious agent.
• Restore the drainage capacity of the bronchi.
• Resume normal lung function.
• Boost immune defenses.

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 I – III generation cephalosporin group, which are combined with aminoglycosides and fluoroquinolones in the following combinations:

• Respiratory ceftazidime and fluoroquinolone.
• Amikacin and one of the antipseudomonal penicillins.
• Monotherapy with IV generation cephalosporin (Cefepim).
• Ceftazidime and Cefipim, Imopenem and II generation fluoroquinolone.

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 are prescribed:

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

The effectiveness of the treatment is tested 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 secreted.
• Reduced blood leukocytosis.

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

Prophylaxis

Lung inflammation can be avoided if the patient is provided with proper care with a range of important procedures.

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

1. 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.
2. Thorough cleaning of the oral cavity: teeth, tongue, gums from food debris.
3. Daily massage (3 to 5 times) of the upper third of the chest
4. Physiotherapy.
5. Inflation of balls, plastic bags, blowing out air through a tube inserted into a container with water.
6. At home, it is recommended to alternate cans and mustard plasters.

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 a humidifier.

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

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

Untreated pneumonia after a stroke is always fatal. In case of untimely treatment, 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 make it possible to identify the development of the disease in time.

What are the causes of the onset 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;
• chronic heart pathologies;
• oppression of consciousness;
• carrying out artificial ventilation of the lungs to the patient, which lasts more than 7 days;
• prolonged lying, immobilized position;
• taking H2 blockers as a treatment.

The following reasons have an effect on the appearance of pneumonia after a stroke:

The causative agents of this disease are most often:

• klebsiella;
• intestinal and Pseudomonas aeruginosa;
• Staphylococcus aureus.

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

1. Aspiration pneumonia. This condition occurs as a result of the ingress of small constituents of food into the upper respiratory tract, which leads to the cessation of the work 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 a severe cough. Worst of all, when bits of food trapped in 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 with a high fever occurs.
2. Congestive pneumonia. This type of disease is mainly diagnosed in bedridden patients, since the constant presence in this position causes serious circulatory disorders of the lungs. As a result of this, ventilation of the lungs is aggravated, and the release of sputum is difficult.

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 develops within 72 hours after the onset of a stroke, it is difficult to notice the symptoms of this complication. This can be explained by the serious condition of the patient after circulatory disorders in the brain, which causes a blurred clinical picture.

However, you can still distinguish 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;
• an increase in the number of leukocytes in the blood;
• mild cough, which is often absent from the victim.

A 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;
• coughing may occur;
• a significant increase in the level of leukocytes in the blood.

If there is a suspicion of pneumonia, the doctor prescribes sputum tests for 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 timely establish the presence of pneumonia even at the initial stage of its development, then the treatment started on time allows us to hope for positive results.

Danger of pneumonia after stroke

It is worth knowing that it is quite easy to catch pneumonia in the hospital. For this, it is enough that the human body is struck by staphylococcus, and the development of a stroke also occurs.

In this case, it is not easy to avoid the appearance of pneumonia, since as a result of this disease, blood circulation is impaired.

In the absence of effective treatment, the patient may develop the following unpleasant consequences:

1. Intoxication - an incompletely cured disease leads to gradual and health-threatening poisoning, which immediately affects the work of the heart muscle.
2. Loss of respiratory function - in order to cope with the situation, the patient needs to install an apparatus for ventilation of the lungs, which complicates the patient's rehabilitation, because to restore health, it is necessary to ensure a normal supply of oxygen.
3. Death - 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 undergoes additional techniques that increase the process of expectoration of exfoliated sputum.

These activities include:

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

Preventive actions

Proper and timely care of a stroke survivor can reduce the risk of pneumonia.

• the headboard should be raised at an angle of 30 degrees;
• alternate coups from one side to another at least 7 times a day;
• high-quality cleaning of the water that the patient drinks;
• massage or kneading the back to induce a cough and increase the quality of expectoration;
• brushing your teeth and caring for the oral cavity;
• high-quality hygiene;
• care of medical items;
• airing the hospital room, which will reduce the number of microbes in the air.

Immediately after discharging it hurts, he should begin to exercise, which will improve cough and quickly remove phlegm. Correct adherence to the 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 frequent and dangerous complication that occurs in half of all patients who have had 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

Stroke pneumonia occurs in bedridden patients due to impaired breathing quality. The loss of quality control of inhalation and exhalation leads to congestion in the lungs, in addition, the weakened body is unable to fight the many bacteria and microorganisms that can provoke pneumonia.

It can be:

• enterobacter and klebsiella;
• coli 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 long-term immobility becomes the cause of the development of stagnation in the pulmonary circulation. Pathogenic microorganisms actively multiply and contribute to the onset 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 termination 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 apoplectic stroke are impaired.

In most cases, patients do not have a cough reflex, phlegm accumulates in the respiratory tract, 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 pneumonia. 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. Congestion 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, which also contributes to the onset of pneumonia, but the most significant causes are changes in blood flow and impaired functionality of muscles, including those supporting breathing.

Diagnostics and the most striking symptoms

Pneumonia after stroke is suspected when, a few days after the stroke:

• the temperature rises slightly and keeps without falling;
• breathing becomes shallow, frequent and difficult;
• both on inhalation and on exhalation, pronounced wheezing and bubbling are heard;
• inhalation is especially difficult;
• shortness of breath is clearly audible 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 at all.

The danger of the disease lies in the fact that early pneumonia proceeds 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 ° due to a violation of the functionality of the center of thermoregulation in the brain.

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

1. A blood test that determines the number of leukocytes and the erythrocyte sedimentation rate. The white blood cell count can be markedly reduced due to the reaction to brain damage.
2. X-ray, which can detect changes in the lung tissue. Such foci are not always visible on the images at once, therefore, the examination is carried out several times and in several projections.
3. Blood biochemistry shows disruptions in gas and acid-base balance. With the help of this study, a protein of the inflammatory process is detected in the blood.
4. Sputum culture.
5. Bronchoscopy.
6. CT scan.

Therapeutic measures and prevention

Inflammation of the lungs that occurs after a stroke requires a special approach. Taking into account the serious condition of patients, forced recumbency, 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 from the nervous system.

For effective treatment, the doctor may prescribe:

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

There is also the so-called symptomatic therapy, which includes taking medications that have analgesic effects, 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 remove intoxication, support and increase immunity.

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

After apoplexy, pneumonia can be avoided by taking care of the simple rules of patient care:

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

Because of what pneumonia is formed after a stroke, what is dangerous and how is it treated

Stroke is primarily dangerous complications caused by an acute lack 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 with 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 disorder. According to the ICD, there are two main types of apoplexy.

• Aspiration pneumonia - develops as a result of food pieces entering the respiratory tract of a person. As a result, the affected segment of the lung tissue stops working. Bacteria in the airways provoke inflammation.

Signs of aspiration pneumonia have manifestations similar to intoxication or poisoning of the body. The first symptom is an excruciating cough. The most difficult to diagnose is radicular pneumonia, since the inflammation spreads to the paramedystial space.

It is most dangerous when large bronchi overlap with pieces of food. It hurts the patient to cough, and over time, pneumonia develops with a temperature.

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 of drug therapy.

Why is pneumonia dangerous in stroke

Treatment of congestive pneumonia in bedridden patients with a stroke does not always begin 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 stagnation are mistakenly attributed to the consequences of a stroke.

• Full or partial loss of respiratory function - connection to a ventilator is required, rehabilitation of the patient 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 blood tests. Leukocytosis is either completely absent, or observed to an insignificant degree.

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 complications from brain damage.

How to prevent post-stroke pneumonia

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

• Pathogen reduction - Prevention of pneumonia depends largely on the efforts of the hospital's medical and maintenance staff to provide the necessary conditions to reduce the unfavorable flora of the upper respiratory tract. Daily sanitation and physiotherapy are provided.

How can pneumonia after a stroke be cured?

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

1. Relief of cerebral edema.

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

Features of pneumonia as complications after stroke

Pneumonia in stroke occupies a leading place in the list of causes of death in patients with cerebrovascular accident. 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

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

All this, as well as a suppressed immune system, makes it possible for the secreted sputum to accumulate in the lungs and respiratory tract, causing inflammation and creating a favorable environment for the reproduction of pathogenic microorganisms.

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

Patients are at risk:

• people with a reduced level of immunity (kidney disease, liver disease, heart disease, etc.);
• those who have crossed the age threshold of 65;
• in the presence of chronic or acute diseases of the oral cavity, nasopharynx;
• overweight;
• in the presence of systemic diseases;
• if the ventilation of the lungs by the apparatus method was carried out for more than 6-8 days;
• with immobility of the patient for a long time;
• if, due to a stroke, there is difficulty in breathing or in the bloodstream in a small circle.

These are not all the reasons for the occurrence of foci of inflammation in the lungs. So, there are frequent cases of bacterial infection of patients after using invasive resuscitation methods, poor disinfection of air conditioners and humidifiers, as well as in the absence of the necessary patient care.

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

Symptoms and diagnostics

It is almost impossible to notice the manifestations of pneumonia in the early form (which arose 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 overall body temperature;
• wheezing and non-specific sounds (gurgling, gurgling) when breathing;
• obvious changes in the tissues of the lungs on radiography;
• in blood tests, as a rule, an increase in the level of leukocytes is observed.

Cough in most cases is absent, or mild and ineffective.

But with a late form of pneumonia (you have to wear it), the symptoms are more pronounced:

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

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

If you notice signs of pneumonia in the early stages, then timely treatment started gives hope for a positive prognosis.

If the use of an X-ray is impossible due to the severe course of the underlying disease, then the diagnosis is established on the basis of general symptoms, as well as the available laboratory data. After confirming the diagnosis and prescribing treatment, a blood test and a number of other general studies are collected daily 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. At the beginning of treatment, antibiotics with a wide spectrum of action are used, and after the pathogen and its resistance to drugs are precisely 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 the appointment of monotherapy (that is, only one drug). Usually, expectorants, phlegm-thinning, diuretic drugs, and drugs that stimulate the cough center (if the patient's condition allows it) are added to the main drug.

If pneumonia is caused by ingestion of food, vomiting into the pulmonary tract, or due to a stroke, the swallowing reflex is impaired, then the food is injected directly into the patient's 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 performed several times until the condition improves.

All drugs in the first days are administered mainly intravenously, and then gradually switch 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 by 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 bronchodilators.

With adequate and timely treatment, the prognosis is quite favorable. But the older the person is, the less chance of 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 careful caring for 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 your teeth after eating;
• massage of the upper back to induce cough and effective expectoration;
• setting the headboard at an angle;
• fairly frequent ventilation of the room to reduce the number of germs in the inhaled air;
• additional purification of used water;
• thorough personal hygiene of medical personnel, timely disinfection of tracheostomy tubes, humidifiers, etc.

Exercise should begin immediately after the doctor's permission, so the cough will become more productive, and blood circulation in a small circle will significantly improve. It is this approach that 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 now reading these lines, victory in the fight against the consequences of the disease is not on your side. It should be noted that the earlier rehabilitation begins, the greater the chance to recover completely. And the likelihood of returning to an active life increases many times over if you recover under the supervision of the specialists of the rehabilitation center.

Read better what Elena Malysheva says about this. Read better what Elena Malysheva says about this. For several years I suffered from the consequences of STROKE - severe headaches, dizziness, heart palpitations, chronic fatigue, pressure surges, shortness of breath even with the slightest physical exertion. Endless tests, visits to doctors, pills did not solve my problems. BUT thanks to a simple recipe, headaches went away, shortness of breath and heart problems disappeared, blood pressure returned to normal, memory and vision improved. I feel healthy, full of strength and energy. Now my doctor is wondering how it is. Here is a link to the article. Here is a link to the article.

Stroke and pneumonia - worse than you can imagine

A stroke in itself is a serious illness that can easily turn a person into a disabled bed. Needless to say, when after one "blow" to health follows a second, no less serious - pneumonia. Most often, a stagnant variant of this disease develops, which is a complication of a previous stroke.

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

Risk factors

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

Often people of the elderly and senile age face pneumonia after a stroke. They normally have impaired drainage function of the lungs, and after a stroke, sputum separation is practically absent, especially if the disease is severe. The risk of pneumonia increases significantly after a person turns 65.

Excess weight in 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, before the stroke, suffered from chronic forms of heart and lung disease.

After a stroke, a person can often be in a coma, this contributes to the development of congestion in the lungs. The reason for this condition is a violation or complete absence of sputum outflow. A similar condition 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 consciousness, the patient is on bed rest, which contributes to stagnant processes in the pulmonary system.

Development mechanism

It's 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 of:

• in an oppressed mind 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 damage to the brain tissue, as well as the place where the hemorrhage or blockage of the vessel occurred. As a result, in some patients, the function of sputum drainage from the lungs is impaired. Reduces or absent the cough reflex or the urge to cough, it is he who is protective and promotes the discharge of sputum. The microorganisms are replaced by more aggressive ones that can cause disease. Further, it is just a matter of time and the disease does not keep itself waiting long, 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. Also, the level of immune defense decreases, the body is unable to resist infection.

Symptoms of the disease

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

Some symptoms can turn on themselves:

• the temperature rises moderately;
• breathing is disturbed by the type of pathological variant of Cheyne-Stokes or Kussmaul;
• as a result of a violation of the cough reflex, there is no sputum separation;
• on auscultation, rales of various sizes are heard.

Features of aspiration pneumonia

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

With aspiration pneumonia, the manifestations resemble intoxication or poisoning. Initially, a cough that is painful in nature draws on itself. The root variant of aspiration pneumonia is difficult to diagnose. High temperature joins, coughing becomes painful. A dangerous option is the situation when a large bronchus is blocked by pieces of food.

Symptoms of late variants

Diagnosis of the late variant of the disease is much easier. Your doctor will need certain symptoms to make a correct diagnosis. 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;
• the x-ray clearly shows pathological changes in the lung tissue.

Final diagnosis

In addition to symptoms, there are some standards for instrumental diagnosis of the problem. 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 addition to stagnant phenomena, the image will clearly show the most intense focus of shading.

Sputum or bronchial lavage is subject to examination. This analysis will make it possible to establish the type of pathogen, after which its individual sensitivity to antibacterial drugs is carried out. This analysis will further allow the doctor to prescribe an effective treatment.

Treatment

In case of pneumonia, which could be complicated by a stroke, measures are aimed at the speedy elimination of hypoxia. The tissues must receive more oxygen, this is done with the help of artificial ventilation or the use of oxygen bags. It is necessary to pay attention to the fact that pulmonary edema often joins, which is why prevention of this condition is also 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. Before this analysis, broad-spectrum antibacterial drugs are shown. The dose of the antibiotic is selected individually, but, as a rule, they are used in large quantities.

Diuretics are used without fail, they help reduce edema and prevent pulmonary edema. Cardiac drugs and expectorants are indicated. If there is a problem with mucus as a result of its viscosity, your doctor may prescribe medications to thin it.

Additionally

After stabilization of the state for a stroke, physiotherapy is recommended for a person. Electrophoresis with potassium iodide is excellent for sputum removal. Exercise therapy under the guidance of an instructor is also shown; it is mainly aimed at restoring breathing.

While still in bed, the doctor may recommend breathing exercises for a person. If the patient is able to breathe on his own, then in bed he is advised to inflate balloons. Special drainage positions are also used to help drain mucus from the lungs. Massage in the acute period is undesirable, but in a mild form it helps to remove phlegm and is performed by a masseur.

Prevent pneumonia

When there is an understanding of the mechanism of development of the disease, it is possible to prevent the development of the disease. 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:

1. It is worth reducing the pathogenic factor, because the risk of developing the disease largely depends on medical workers, the quality of their performance. In the intensive care unit, in addition to the treatment of instruments and surfaces, the bronchial tree must be sanitized.
2. It is required to carefully observe the rules of hygiene, including personal. Medical professionals should adhere to the rules of asepsis and antiseptics.
3. The tube that is used for ventilation of the lungs must be used for individual use and after use is processed and disposed of. The same applies to the rest of the instruments that may come into contact with the human respiratory system.

Prophylaxis

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

Initially, it is worth providing 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 several.

It is imperative that oral hygiene is carried out 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 are carried out no earlier than an hour and a half after the last meal. It is useful to inflate baby balloons. Additionally, a special massage is carried out for about three sessions throughout the day.

As the symptomatology of a person's stroke regresses, it is necessary to activate, first in bed, and then within the ward. This approach will prevent the accumulation of phlegm and prevent congestion.

What to do with pneumonia after a stroke?

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

Clinical picture

Factors contributing to the development of pneumonia after stroke:

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

The reasons for the development of the disease:

Experts identify the following symptoms of the disease:

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

Staphylococcus aureus is the causative agent of pneumonia.

Common causative agents of the disease are:

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

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

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

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

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

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 are used (from various groups). After 5 days, the course of therapy is adjusted taking into account the reaction of the body, the identified type of pathogen, the sensitivity of the virus to chemotherapy.

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

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

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

In a severe course of the disease, integumentary tissues may die. If this process penetrates deeply, then the wound becomes infected, the body becomes infected. Prevention of pressure sores consists in regular changes in body position (1 time in 2 hours). The skin is treated with warm camphor alcohol. If the work of the large intestine is disrupted during pneumonia, you will need to follow a diet. The diet includes fiber and dairy products. For constipation, take a laxative. You need to drink up to 2 liters of liquid per day.

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

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

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

Do not take antibacterial drugs to prevent pneumonia.

Pneumonia during and after stroke

Why does pneumonia occur?

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

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

• Failure of swallowing and coughing reflexes
• Decrease in the rate of microcirculation of blood in the bronchi
• Interruption of the supply of nutrients and oxygen to the respiratory system
• Dysfunction of the bronchial drainage system
• Displacement of normal pathogenic microflora, contributing to the development of infection.

Aggravates the condition of the patient with ischemic stroke or after it, the forced constant 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:

• Advanced age (over 65)
• Long-term (more than 7 days) artificial lung ventilation
• Overweight patient
• Chronic cardiovascular disease
• Respiratory pathology
• Hyperglycemia
• Uremia
• Long hospital stay
• 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 on 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 the underlying disease. The belated determination of pneumonia leads to the fact that by the time of diagnosis, 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 with the underlying ailment. In this case, the picture is clearer, and doctors are quicker to navigate the diagnosis. In severe strokes, the symptoms of pneumonia are usually more subtle and therefore difficult to identify.

How does pneumonia develop

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

Early pneumonia develops within 2-3 days of being in the hospital. Its development is caused by violations in the regulation of the central nervous system.

The disease is manifested by fever, wheezing when breathing, 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 badly.

Late pneumonia develops after 2-6 weeks of hospitalization. It is provoked by hypostatic processes arising from a lying position. Normal blood circulation in the small pulmonary circle is disrupted, fluid accumulates in the lungs. The disease is difficult to diagnose and can be fatal as a result of delay in treatment.

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 (an increase in temperature to 38 ° or a 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.

Pneumonia treatment

The main directions of therapy:

• Suppression of the inflammatory process
• Neutralizing infection
• Preventing cerebral edema
• Restoration of the drainage function of the bronchi
• Resumption of normal lung function
• Boost immunity
• Prevention or treatment of complications.

To suppress the inflammatory process, drugs with an antibacterial effect are primarily prescribed. The appointment is made based on the patient's condition, determining the type of causative agent of the disease, 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 establish the exact 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, which has developed in a hospital setting. 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 therapy scheme is adjusted. Performance indicators are:

• Decrease in temperature
• Reducing the amount of sputum secreted with pus
• Decreased leukocytosis
• Slowing down or stopping the inflammatory process.

Further appointment is made on the basis of the data obtained from the previous treatment. The duration of antibiotic use 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. For this, drugs with expectorant and mucolytic effects are prescribed, physiotherapy procedures are carried out: massage, breathing exercises.

In case of a severe form of the disease, patients undergo a 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 an influx of fresh air: ventilate the room more often, taking the necessary precautions to prevent hypothermia of the patient.

Perform oral hygiene. This will prevent the infection from developing. If the patient is not able to carry out the procedures on his own, you will need to help him with this.

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

If the patient's condition allows, it is necessary for him to provide a reclining position (at an angle of 45 °) - it will improve ventilation of the lungs.

Massage therapy is necessary to improve the separation and release of phlegm. 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. The procedure is recommended to be carried out as often as possible, one and a half hours after a meal.

Banks or mustard plasters.

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

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

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 patient's health 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 of stroke, bacterial pneumonia develops. It arises against the background of uncontrolled reproduction in the body of Staphylococcus aureus, Klebsiella, E. coli and Pseudomonas aeruginosa, etc.

Risk factors for pneumonia after stroke include:

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

In addition, prolonged use of antacid medications 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 stagnant processes in the lungs. This is due to the fact that when the body is in a horizontal position for a long time, stagnation of blood is formed in the vessels of the body. In the event of a 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 phlegm, and the lungs can no longer perform full gas exchange.

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

Stroke and pneumonia can cause death if the patient does not receive timely medical attention.

Treatment

Treatment of pneumonia should be aimed at eliminating oxygen starvation (hypoxia), inhibiting the development of pathogenic microorganisms and restoring breathing.

Stroke pneumonia is treated by using:

• Antibacterial therapy. If the disease is at an early 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 with the use of Meropenem, Tobramycin or Ciprofloxacin. In order to increase the effectiveness of treatment, you can combine the intake of some antibacterial agents. The duration of antibiotic use can vary depending on the severity of the disease.
• Oxygen therapy. It is carried out using mechanical ventilation (artificial lung ventilation) and is designed to maintain normal respiratory function. 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.). These medications help clear mucus from the lungs.
• Immunomodulatory agents. These include Timalin, Dekaris, 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 prescribed special procedures. It can be a complex of breathing exercises that restore breathing functions, vibration or manual massage of the chest.

5 days after the start of treatment, the doctor must conduct a diagnosis in order to assess the effectiveness of the therapy. The effectiveness of the treatment course will be evidenced by the intensive excretion 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 the occurrence of various complications. If the treatment of the disease is not carried out properly, then the sick person may have the following problems:

• Deterioration of lung contractility. In this case, the violation of the contractility of the lungs can be complete (when a person is not able to inhale) or partial (when it is possible to inhale, but with great difficulty).
• Intoxication (poisoning) of the body. Most often it occurs against the background of untreated pneumonia. Intoxication has a negative effect on the functioning of all human organs and its cardiovascular system.
• Congestive pneumonia. If pneumonia 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 what degree of severity the pneumonia will have at the time of its treatment. The sooner the disease is detected and treated, the more likely a person will be to overcome the disease.

Leading specialists in the field of neurosurgery:

Balyazin Viktor Alexandrovich

Balyazin Viktor Alexandrovich, Professor, Doctor of Medical Sciences, Honored Doctor of the Russian Federation, Excellence in Healthcare of the Russian Federation, Neurosurgeon, Head of the Department of Nervous Diseases and Neurosurgery

Vladimir Moldovanov

Vladimir Moldovanov, Candidate of Medical Sciences, Doctor of the highest qualification category, 35 clinical experience

Savchenko Alexander Fedorovich

Savchenko Alexander Fedorovich, Candidate of Medical Sciences, Doctor of the highest qualification category, Head of the neurosurgical department of the emergency hospital number 2

A. A. Rastvorova (Moscow)

Pulmonary edema is a kind of formidable syndrome, which is sometimes observed with disorders of cerebral circulation. With pulmonary edema, extravasation occurs from the capillaries into the pulmonary alveoli and stroma. In the pathogenesis of pulmonary edema, a violation of nervous regulation is important, causing an increase in permeability and an increase in pressure in the capillaries.

The importance of the nervous system in the pathogenesis of pulmonary edema is confirmed by the experimental studies of A.D.Speransky, K.M.Bykov with co-workers, A.V. Tonkikh,

GS Kahn et al. Acute pulmonary edema can occur with failure of the left ventricle of the heart. In this case, the state of increased excitability of the stem and hypothalamic centers of respiration is of significant importance.

A number of authors who studied clinical and pathological changes in the lungs in the acute stage of cerebral stroke pay great attention to the role of impaired nervous regulation in the genesis of pulmonary edema. The frequency of pulmonary edema in stroke is different according to the authors (15% according to N.K.Bogolepov, 9% according to Luisada).

Pulmonary edema with cerebral circulation disorders occurs acutely. Its occurrence may be associated with the nature of the pathological process (more often with hemorrhagic stroke), localization of the lesion (ventricular, hemispheric, cerebellar, stem) and the period of cerebral stroke.

Of the analysis carried out by N.K.Bogolepov and his co-workers, 666 cases of cerebral stroke observed in an ambulance on the first day, pulmonary edema was observed in 18 patients (0.34%). Pulmonary edema in stroke patients is observed in terminal conditions. According to Camezan ,. of 66 autopsies of those who died from cerebral hemorrhage, 44 had pulmonary edema. NK Bogolepov often noted pulmonary edema with hemorrhage in the hemisphere with a breakthrough in the ventricles of the brain, flowing with hormetoia.

The paper presents data from “a study of 224 patients with cerebral stroke who developed pulmonary edema.

Stroke etiology: hypertension - 132 patients, cerebral atherosclerosis - 76 patients, cerebral aneurysm - 8 patients, rheumatism - 8 patients. There were 11 patients under the age of 30, and 27 from 31 to 40 years old. from 41 to 50 years old - 28, from 51 to 60 years old - 49, from 61 to 70 years old - 56, over 71 years old - 53 patients.

Pulmonary edema was observed in 148 hypertensive patients with hemorrhagic stroke. Parenchymal hemorrhages were observed in 145 patients, subarachnoid hemorrhages - in 3 patients. Hemorrhages in the cerebral hemispheres were determined in 126 patients, in the brain stem and in the cerebellum - in 17 patients, 2 patients had combined hemispheres and brain stem. Hemorrhage with breakthrough of blood into the ventricles of the brain was in 72 patients. With hemorrhages c. cerebral hemispheres not complicated by ventricular hemorrhage, 34 patients had latero-capsular hematoma localization, 20 patients had mediocapsular hematoma, with capture of subcortical nuclei.

Pulmonary edema in patients with hemorrhagic stroke developed mainly in soporic-coma in the terminal period of stroke, more often on days 3-6 of the disease. In the clinical picture of stroke, the phenomena of cerebral edema with compression of the brain stem were observed. Respiratory disorders of the obstructive type due to a coma, loss of reflexes from the mucous membranes of the upper respiratory tract, as well as bulbar or pseudobulbar paralysis were combined with a violation of the central regulation of respiration (changes in the rhythm, frequency and structure of the respiratory cycle). Insufficient oxygenation of the blood, which was observed in most patients in the acute period of cerebral stroke, led to a sharp disruption of oxidative processes in tissues and the accumulation of under-oxidized metabolic products. Hypoxemia promoted an increase in cerebral edema and an increase in secondary dislocation phenomena. Thus, in patients with hemorrhagic stroke, pulmonary edema developed against the background of prolonged depression of the stem functions and respiratory disorders.

In ischemic stroke, pulmonary edema was observed in 76 patients. 21 patients had cerebral infarction due to thrombosis of cerebral vessels, 55 - non-thrombotic, softening. Localization of softening foci in the cerebral hemispheres prevailed (63). Softening in most observations was extensive, and the white matter of the cerebral hemispheres and subcortical nuclei were affected. In 3 cases, there was a combined softening in the cerebral hemispheres and the brain stem (Table 1).

Among patients with ischemic stroke, two groups could be distinguished. In the first group of patients, predisposing

lagging factors in the development of pulmonary edema were heart diseases: atherosclerotic and postinfarction cardiosclerosis, mitral heart disease with a predominance of stenosis, myocardial infarction. These patients showed cardiac arrhythmias (atrial fibrillation, group extrasystole), as well as impulse conduction disorders (atrioventricular block of various degrees). Phenomena of circulatory failure with increased pressure in the pulmonary circulation and congestion in the lungs were observed. Some patients in this group had lung diseases: emphysema, pneumosclerosis, pneumonia, as well as pulmonary heart disease. Consequently, in patients of the first group, cerebral stroke occurred against the background of a severe somatic illness. Pulmonary edema sometimes occurred in the initial period of stroke, causing profound hemodynamic disturbances, dyscirculatory and hypoxic disorders, especially when there was a drop in blood pressure, which aggravated cerebrovascular insufficiency.

In the second group of patients with ischemic stroke complicated by pulmonary edema, the development of pulmonary edema was caused by cerebral stroke. No phenomena of cardiopulmonary failure were observed, but pulmonary edema was preceded by pulmonary complications: pneumonia, atelectasis. Pulmonary edema developed in the terminal period of ischemic stroke, when symptoms of brain stem damage were expressed. In patients who were in a soporic-comatose state, disorders of autonomic and respiratory functions were found.

In patients with hemorrhagic and ischemic stroke, several variants of the clinical course of pulmonary edema were noted. The most common form of pulmonary edema was acute, lasting several hours. On the first day of stroke, it occurred in patients with severe cardiopulmonary pathology, circulatory failure. In other patients, this form of pulmonary edema was observed in the terminal period, sometimes against the background of pneumonia. With a protracted form, clinical manifestations of pulmonary edema were noted for more than a day. It met equally often in the terminal period of hemorrhagic and ischemic stroke in patients who did not suffer from heart disease in the past.

Rarely there was a "fulminant" form of pulmonary edema, lasting about an hour. It developed in patients with violent cerebral stroke (ventricular hemorrhage), sometimes in combination with acute cardiopulmonary failure due to myocardial infarction or pulmonary embolism.

The study of the relationship between pulmonary edema and cerebral stroke revealed a number of patterns. More often, pulmonary edema occurs with strokes of hemispheric localization and the involvement of the brain stem in the process. Most often, pulmonary edema occurred in that stage of stroke, when, with extensive hemorrhage or ischemic softening, the phenomena of diffuse brain damage join. In this case, the leading were the dysfunctions of the hypothalamic-stem sections due to either their direct 'damage, or as a result of edema and dislocation of the brain. In these cases, pulmonary edema could not be considered as a manifestation of left ventricular failure: it was caused by damage to the centers of autonomic regulation and extreme expression of autonomic disorders. In this regard, it becomes clear that the prevalence of cerebral circulation disorders complicated by pulmonary edema, hemorrhagic strokes (65%), which, due to the severity and characteristics of their course, cause an increase in intracranial pressure, edema, dislocation and damage to the hypothalamic-stem structures of the brain.

In some cases, especially with the development of pulmonary edema c. the first day of the disease, it was possible to associate its occurrence mainly with cardiopulmonary insufficiency. Heart disease in many cases caused cerebrovascular insufficiency, and pulmonary edema in these patients was a manifestation of cardiac decompensation.

Thus, pulmonary edema in stroke has a complex pathogenesis and depends on the severity, nature and stage of stroke, as well as the state of the cardiovascular and pulmonary systems.

It is extremely important to recognize the initial symptoms of pulmonary edema in order to prevent the development of pathological phenomena. Identifying the pathogenesis of pulmonary edema is important for active therapy aimed at. elimination of pulmonary edema, the fight against hypoxia and cardiovascular failure.

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Stroke is a fairly common occurrence, after which a huge number of people die every year. Patients who have undergone it are forced to struggle with unpleasant and serious consequences for a long time. And almost every person faced with this problem suffers from edema resulting from circulatory disorders.

Since it is almost impossible to predict a stroke, people, as a rule, are unprepared and do not know how to deal with edema. In some cases, their occurrence can be prevented or reduced.

Lower and upper limbs

The first weeks after a stroke, the patient may experience swelling in the paralyzed limbs. This phenomenon is very common. It arises as a result of weak activity of the arms and legs, when the circulation of lymph and blood is disturbed.

Another common cause is the presence of blood clots in deep veins. In this case, pain is felt on the thrombotic area of ​​the body when pressed. The temperature of the sore arm or leg is elevated.

Deep vein thrombosis is a very dangerous disease that requires consultation with a specialized doctor and a decision on further treatment tactics.

To prevent and treat edema of the extremities after a stroke, the following recommendations must be followed:

To prevent the appearance of swelling of the arms and legs after a stroke, the following measures should be taken:

Brain

Cerebral edema is a serious, life-threatening condition in which excess fluid builds up directly in the tissues of the brain. As a result of the accumulation of fluid, an increase in the volume of the brain is observed. Increasing intracranial pressure causes very severe headaches.

Cerebral edema develops as a result of a decrease in the intensity or complete cessation of blood circulation. In this case, the severity of the edema depends on the severity of the brain damage.

As medical practice shows, for more than half of cases of cerebral edema, the forecasts are rather disappointing.

The symptoms of this complication of the disease are:

The latter symptoms are very dangerous, since loss of consciousness after a stroke can also turn into a coma. The prognosis in such cases is very unfavorable: only 40% of patients manage to get out of a coma, the rest is fatal.

Cerebral edema usually appears 1–2 days after a stroke, with a peak at 3–5 days.

To alleviate the patient's condition, it is necessary:

1. Reduce body temperature.
2. Stop pain.
3. Put the patient in a semi-sitting position so that the head is in an elevated state.

Treatment

If brain edema is suspected, urgent hospitalization is required. Oxygen therapy, intravenous infusion of drugs, diuretics are used as therapeutic measures.

In extremely severe cases, a part of the cranial bone may be removed to the patient in order to reduce the pressure on the brain tissue, as well as to ensure the outflow of fluid.

Lungs

The lungs are a vital organ that supplies oxygen to the body. As a rule, pulmonary edema on the background of a stroke occurs suddenly and is accompanied by shortness of breath and the threat of suffocation. It is impossible to cope with this problem on your own at home, therefore, if you find the first signs in a patient, you must immediately call a doctor.

With the sudden development of pulmonary edema (most often the attack begins at night), the patient begins to worry about severe suffocation. At the same time, his breathing becomes extremely difficult.

After 2-3 minutes, the patient begins to cough abruptly and convulsively. First, the usual sputum comes out with a cough, which happens with a simple cough, and then, if the swelling progresses, the patient begins to cough up bloody fluid and foam.

A person's breathing becomes difficult, his face turns pale. In some cases, clammy cold sweat may appear. The patient is seized with panic. An attack can last up to 30 minutes, during which it is necessary to have time to provide him with qualified medical care. If this is not done, the person may die.

If even the attack has passed before the ambulance has arrived, it must be remembered that pulmonary edema can proceed in waves and after the first attack a second one can follow.

In some cases, the lungs after a stroke swell sluggishly, slowly, the disease becomes chronic (in such cases, we are talking about chronic stagnation in the pulmonary circulation).

With pulmonary edema, the task of doctors is to reduce stagnation in the pulmonary circulation, suppress the foaming process, restore airway patency, eliminate oxygen starvation, and normalize blood pressure.

Treatment consists in the use of cardiac drugs, inhalations with oxygen in combination with alcohol vapors. In extremely rare cases, they resort to bloodletting aimed at unloading the pulmonary circulation. In severe cases, morphine is used. With progressive edema, the patient is prescribed diuretics.

It should be noted that most often when symptoms of pulmonary edema occur, first aid is provided at home, since transportation of the patient to the hospital can result in irreparable consequences. Inpatient treatment is usually carried out after the crisis has subsided.

Swelling that occurs after strokes requires proper treatment by qualified professionals. However, one should not forget that a favorable outcome and speedy recovery of the patient also largely depends on the responsibility, care and patience of the people around him.