Pneumonia as a complication of stroke. What is the danger of pneumonia after a stroke in bedridden patients and survival prognosis Congestive pneumonia in stroke patients

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 - the prevention of 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.
Combating 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.

One of the most dangerous complications in patients after acute cerebrovascular accident is pneumonia. According to statistics, in 50% of cases it occurs as a complication of ischemic stroke, in 35% - hemorrhagic, and in 45% - subarachnoid. In almost 15% of them, pneumonia is fatal.

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
Therapeutic gymnastics.
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.

When a person is seriously ill, he is constantly in bed. Regardless of age, he requires constant care. If you do not care for it correctly, complications may arise in parallel with the underlying disease. Congestive pneumonia in bedridden patients is a disease that occurs as a result of congestion in the body during prolonged bed rest.

What you need to know about pneumonia in bedridden patients

When a bedridden patient appears in a family, the life of this family changes. Often patients live out their last days in this situation. At this time, a person’s life depends on the care and attentiveness of a nurse. Good care in some cases can get the patient back on his feet, but bad care can shorten his life.

Typically, a bedridden patient is not able to roll over on his own. And if he is not helped with this, over time the body stagnates, problems with the heart, gastrointestinal tract, and lungs begin.

Pneumonia in bedridden patients occurs quite often and in most cases ends in death. This happens because the disease often occurs in a latent form, its symptoms are blurred, and the diagnosis may be made late.

A person who cares for a patient must be very attentive to his patient. Constantly monitor his general condition, mood and physical activity. Any changes must be recorded and reported to the doctor.

If the diagnosis is made early in the disease, the patient will have a chance of recovery. When the process is started, he has no chance not only to recover, but also to continue to live. This is especially dangerous in old age, when the body is worn out and no longer fights diseases. In this case, the prognosis is extremely unfavorable.

The mechanism of breathing and the causes of congestion

Prolonged immobilization of a sick person leads to stagnation of the blood of the small circulation passing through the lungs. During the breathing process, it is very important that the movements of the chest during inhalation and exhalation are harmonious. If the patient is constantly in a lying position, the amplitude of the chest is limited. The worse the patient's condition, the harder it is for him to breathe.

The act of breathing is a reflex regulated from the respiratory center, which is located in the brain:

During inhalation, the chest should expand due to the movement of the diaphragm and external muscle contractions. This creates negative pressure in the chest, which leads to the filling of the alveoli with air entering the respiratory tract from the environment.
At the same time, blood flow occurs in the pulmonary artery.
Meeting in the alveoli, the air saturates the blood with oxygen, taking carbon dioxide from it. This is how gas exchange occurs, and after it exhalation should occur. It is possible due to internal muscle contractions and relaxation of the diaphragm.
Pressure increases in the chest cavity, pushing air and blood out of the lungs. Foreign impurities in the form of dust, mucus and various microorganisms are removed from the lungs with air.

This is the breathing mechanism of a healthy person. In bedridden patients, the range of movement of the chest is limited, and respiratory movements do not occur fully. As a result, air and blood are not completely pushed out of the lungs, blood stagnates in the vessels, and mucus is retained in the lungs.

In most cases, this phenomenon develops in the body of an elderly person. This is due to the fact that old people already suffer from cardiovascular and pulmonary diseases. Being without active movement for a long time, an already worn-out body is most susceptible to stagnation.

Young people with weak cardiovascular systems and weakened immune systems are no less at risk.

People who have had surgery are also prone to developing pneumonia. Pain in the wound after surgery is the reason that the patient begins to breathe carefully, superficially. This causes stagnation. It is enough for an infection to appear, and problems begin in the lungs.

What is the danger of this pathology?

The disease is very dangerous. During it the following happens:

Parts of the lungs in which fluid has sweated into the alveoli and lung tissue stop working during breathing. This is the danger of hypostatic pneumonia; a person begins to lack air.
In addition, bedridden patients are not able to fully cough up sputum. As it accumulates, it clogs the bronchi, causing an even larger area of the lungs to stop working.
Then complications occur that affect the entire body. An inflammatory process begins in the lungs. It is caused by an infection that easily attaches to a weakened body.
The waste products of bacteria begin to poison the patient’s body, affecting the heart and gastrointestinal tract. The patient's appetite decreases and he stops eating. Because of this, he does not receive the required amount of vitamins and proteins that he needs so much at this time.

In severe cases, exudative pleurisy and pericarditis develop. This is an effusion of inflammatory fluid into the pleural cavity and into the cardiac sac. This condition is very dangerous. Respiratory failure worsens further, and the heart, compressed by fluid, is unable to function properly.

Symptoms of pneumonia in bedridden patients

In immobilized patients, the symptoms of pneumonia differ from usual. High temperature rarely appears; more often it remains normal or low-grade.

For a bedridden person, congestive pneumonia is very insidious. Often it is disguised as symptoms of the disease due to which the patient is forced to stay in bed. For example, a patient with a stroke becomes a little more inhibited and inadequate than before. Or a patient with a fracture due to osteoporosis begins to complain that he has pain in his chest.

To notice these changes, the relatives of the sick person need to be very attentive. In most cases, neither the patient himself nor those who care for him notice this.

When specific signs indicating the presence of congestive pneumonia appear, it may already be too late to treat. It may appear like this:

Initially, a dry cough occurs, which intensifies over time, and sputum begins to be discharged. It is mucopurulent, maybe with bloody streaks.
But if the patient is elderly, he may not have a cough reflex. Then his breathing becomes difficult, heavy, due to the accumulation of phlegm in the lungs.
Body temperature rises slightly. In bedridden patients, the body stops responding to pyrogenic substances that cause an increase in temperature.
The patient begins to sweat heavily. If previously he could change his bed every few days, now his linen is damp after every time he sleeps.
The patient becomes lethargic, apathetic, he loses interest in everything around him.
He refuses to eat, feels nauseous, and may have vomiting and diarrhea.
Increased heart rate and pain are observed in the heart and blood vessels.
At rest, the patient experiences shortness of breath, breathing quickens to 20 per minute, and he lacks air. This indicates that part of the lungs has stopped working.

In severe cases of pneumonia, the patient's consciousness becomes confused. He sleeps a lot and stops waking up, does not answer questions or answers incoherently, his consciousness is depressed. In this case, breathing can be very rare or very frequent. In this condition, it is necessary to call an ambulance and send the person to the hospital. He needs resuscitation measures, otherwise he will not be able to survive this.

Diagnostics

The therapist may notice congestive pneumonia during auscultation. In the lower parts of the lungs, wheezing or pleural crepitus can be heard. The diagnosis is clarified based on the results of radiography. It can be carried out using a stationary X-ray machine, specially adapted for such patients. Some ambulances are equipped with them. But the safest thing to do is to place the patient in a hospital, where he will undergo all the necessary examinations and be provided with optimal care.

When pneumonia is detected, in order for the doctor to prescribe the correct treatment, it is necessary to find out what type of infection caused the disease and what the nature of the inflammation is. Therefore, two sputum tests are taken from the patient. One is sent to the bacteriological laboratory, the second to the clinical laboratory. The patient is also given:

Ultrasound of the heart;
electrocardiogram;
General and biochemical blood test.

Pneumonia can develop rapidly. AND The sooner the diagnosis is made, the greater the chance of recovery. Otherwise, life expectancy with pneumonia in bedridden patients is very short, the count can go on for days.

Treatment

Congestive pneumonia is difficult to treat. The body of a bedridden patient is weakened by the underlying disease and is not able to fight the new disease. Therefore, he requires complex therapy:

Having identified the causative agent of pneumonia, the doctor prescribes the drug that will act directly on it. For seriously ill patients, it is prescribed intravenously in the first days, then switched to tablets.
Along with antibiotics, antifungal drugs are also prescribed, because pneumonia can be caused not only by bacteria, but also by fungi in the form of mold.
In order to relieve the patient of congestion in the lungs and veins, diuretics are prescribed.
If the patient has a cough reflex and is able to cough up, he is prescribed mucolytic and bronchodilator drugs to remove sputum.
In the absence of a cough reflex, sputum is pumped out with a special apparatus.
Patients in serious condition are placed in intensive care and connected to artificial ventilation.
Attention is paid to the state of the cardiovascular system, and appropriate medications are prescribed.
Vitamin therapy and immunostimulants are also prescribed.

It is very important to provide the patient with proper care during this period. He is admitted to the hospital, where he is monitored by medical staff. Relatives are allowed to care for seriously ill patients.

The patient must be turned over regularly to avoid new congestion. When the condition improves, it is recommended to carry out breathing exercises.

It is important that the patient eats well during this period. If he can chew food on his own, he is fed food rich in vitamins and proteins. If he is unconscious, food is given through a tube with ground foods. It is recommended to drink vitamin decoctions in large quantities.

Preventive measures

Prevention of pneumonia in bedridden patients involves proper and constant care. His body is fighting the disease and now it is important to prevent stagnation from occurring in it. Prevention includes a set of measures:

Every two hours the patient is turned over to change his body position. He should be regularly turned on his stomach - this way the lungs are better cleansed.
When the patient is on his stomach, he needs to wipe his back with camphor alcohol to avoid the development of bedsores and congestion in the lung area.
At the same time, it is recommended to perform a relaxing massage on the back.
Every day the patient must perform breathing exercises.
The room where the sick person is lying must have an optimal air temperature. It must be regularly ventilated and cleaned. In this case, care must be taken to ensure that the patient does not enter the draft zone.
The patient must be dressed and covered in such a way that he is not hot or cold.
Nutrition should be complete.
A bedridden patient should be visited regularly by a doctor.

It is necessary to monitor the patient's temperature, blood pressure, respiration and heart rhythms. In case of deviations from the norm, you must inform your doctor.

Congestive pneumonia is a dangerous disease that claims the lives of many patients and ranks fourth in mortality among bedridden patients. But it can be cured if you notice it in time and take the necessary measures.

The relevance of cerebral strokes in the world is very high: strokes share with myocardial infarction the first place among the causes of mortality in the population. Pneumonia as a complication after a stroke occurs in 50% of cases of severe stroke.

Pneumonia, which occurs in patients with strokes, significantly worsens the condition of patients and often leads to death.

Causes of pneumonia after stroke

Most often, bacterial pneumonia develops against the background of a stroke. At the same time, the causative agents of pneumonia after a stroke in most cases are nosocomial infections - Pseudomonas aeruginosa and Escherichia coli, Enterobacter, Klebsiella, Staphylococcus aureus. This is explained by the fact that after severe strokes, patients are in a hospital setting.

Factors that aggravate the condition of patients and contribute to the development of pneumonia in them are:

The breathing process is controlled by the respiratory center, which is located in the brain stem. This area of the brain has many chemoreceptors that respond to any change in blood gas composition.

With an increased level of carbon dioxide in the blood, the respiratory center is activated and sends impulses to the respiratory muscles, which, by contracting, raise the ribs and thus increase the volume of the chest cavity. This is how you inhale. After the blood is saturated with oxygen, to which the chemoreceptors of the respiratory center react, the respiratory muscles relax and the chest cavity decreases - exhalation.

Paralysis of the respiratory muscles also leads to difficulty removing mucus from the lungs. Without control of the respiratory center, the act of breathing cannot be carried out, therefore the most dangerous to the patient’s life are hemorrhagic and ischemic strokes of the brain stem.

Pneumonia during stroke in bedridden patients occurs due to congestion in the lungs. Prolonged immobilization or simply a horizontal position of the patient contributes to stagnation of blood in the pulmonary circulation. With venous stagnation in the alveoli, the liquid part of the blood is sweated out and its formed elements (leukocytes and erythrocytes) are released. The alveoli are filled with exudate, and gas exchange can no longer take place in them. The presence of microflora in the lungs provokes inflammation in the alveoli.

In the unconscious state that often accompanies severe strokes, vomit or stomach acid may enter the patients' respiratory tract. As a result of aspiration of these fluids, an inflammatory process develops in the lungs.

Clinic and diagnosis of post-stroke pneumonia in bedridden patients

The occurrence of pneumonia after a stroke is a life-threatening complication of brain damage.

According to the time and mechanism of development, post-stroke pneumonia is distinguished:

Early;
Late.

Early pneumonia develops in the first 7 days after a stroke and is associated with damage to the respiratory center and disruption of the breathing process.

Late pneumonia is hypostatic and is associated with stagnation of blood in the pulmonary circulation. As a rule, they occur against the background of positive dynamics of the stroke, so the prognosis for such pneumonia is more favorable. This classification of pneumonia is necessary for choosing treatment tactics for the patient.

The main signs of pneumonia in bedridden patients after a stroke are:

increase in body temperature to 38.5-39°C;
difficulty breathing (especially inhalation);
dyspnea;
in unconscious patients - pathological types of breathing (Cheyne-Stokes, Kussmaul);
cough (at first painful, dry, and after a few days - wet);
chest pain that gets worse with breathing;
discharge of mucopurulent sputum, often streaked with blood.

Very quickly, bedridden patients develop intoxication syndrome, which manifests itself:

severe muscle weakness;
lack of appetite;
chills;
nausea and vomiting;
headaches;
disturbance of consciousness.

Often, early pneumonia against the background of a severe stroke is not immediately diagnosed, since pronounced neurological symptoms “mask” the clinical manifestations of inflammation in the lungs.

This leads to medical errors and late diagnosis. Diagnostic criteria for early pneumonia in severe stroke include:

often, instead of hyperthermia, a decrease in body temperature below 36°C may be observed (this is due to damage to the thermoregulation center in the brain);
a pronounced increase in leukocytes in the blood or a decrease in their number below normal does not always indicate an infectious process in the lungs (may be a reaction to brain damage);
sputum discharge may not be observed (due to a violation of the respiratory act and drainage function of the bronchi) or, conversely, the release of purulent sputum may indicate activation of a chronic infectious process in the upper respiratory tract;
Some locations of inflammation in the lungs may not be detected by traditional X-ray examination, so X-ray images must be taken several times with a break of a day and in at least two projections.

To identify pneumonia in post-stroke patients, it is necessary to conduct a number of additional research methods:

Treatment of pneumonia after stroke and possible complications

The treatment tactics for a patient with pneumonia after a stroke depend on the patient’s age, the cause and duration of development of pneumonia, the type of pathogen, the severity of the patient’s condition, the severity of neurological symptoms, and concomitant pathologies.

The complex of therapeutic measures for pneumonia after a stroke includes:

To prescribe antibacterial therapy for pneumonia, it is not necessary to wait for the results of bacteriological sputum tests.

Immediately after the diagnosis of pneumonia, empirical antibiotic therapy is prescribed, which can be adjusted if it is ineffective after receiving culture results. The choice of antibiotic depends on the time of onset of pneumonia, since the cause of such pneumonia is different pathogens:

The respiratory function of the lungs is supported with oxygen therapy or by connecting the patient to a ventilator.

The entry of oxygen into the lungs and the removal of carbon dioxide from them significantly improves the condition of patients, since it reduces the manifestations of oxygen starvation of body tissues. There is a normalization of the gas composition and acid-base balance in the blood, which affects all metabolic processes in the body.

Improving the drainage function is carried out by prescribing bronchodilators, mucolytics and bronchodilators (Bromhexine, Acetylcysteine, Euphyllin), but is only important when the patient is breathing independently. When connecting it to a ventilator, sanitation of the bronchi must be carried out artificially (by suctioning their contents).

Immunomodulatory treatment for pneumonia after strokes includes immunomodulators (Timalin, Dekaris), immunoglobulins, and administration of hyperimmune plasma.

The volume and duration of conservative therapy for pneumonia during stroke is determined by the attending physician or resuscitator (depending on the place of hospitalization of the patient and the severity of his condition) based on the dynamics of the patient’s condition and indicators of laboratory and instrumental research methods.

If pneumonia after a stroke is not treated, the disease is fatal in 100% of cases, since the patient’s weakened immune system cannot cope with the infection on its own. If treatment for pneumonia is started untimely or its tactics are incorrect, the patient may develop complications.

Complications of pneumonia after strokes include:

asphalt formation of the inflammatory focus;
gangrene of the lungs;
exudative pleurisy;
pulmonary empyema;
pneumosclerosis;
infectious-toxic shock;
multiple organ failure.

Acute respiratory failure, which can complicate the course of pneumonia after a stroke, can be fatal in a short period of time.

Prevention of pneumonia after stroke

It is very difficult to treat pneumonia due to a stroke, therefore, after hospitalization of the patient, it is necessary to immediately begin a set of preventive measures aimed at preventing its occurrence. This complex includes:

Doctors monitoring a patient in a hospital need to have increased alertness regarding the development of such a life-threatening stroke complication as acute pneumonia.

People caring for bedridden patients at home should carefully monitor all changes in symptoms in a patient with a stroke, especially in the respiratory system.

If the first signs of pneumonia appear, you should immediately consult a doctor so as not to waste precious time. The prognosis for recovery of patients with pneumonia due to strokes improves significantly with early diagnosis and timely treatment.

Mom after a stroke, the left side is paralyzed, does not speak, swallowing functions are present, we cannot chew. After discharge, cystitis began with a urinary catheter, the catheter was removed. We took Augmentin and Ciprofloxacin for 5 days. We also take Ramilong plus 1 time per day, Digoxin 0.25 half a tablet per day, Magnecard and Dialtiazem 1 per day and Encephabol 3 times a day. Now wheezing has begun, temperature is 37.4 - 36.9. When turning over, a cough begins. Should I start taking an expectorant and continue taking Augmentin?

Answer

Hello. There are several causes of cough after a stroke:

foreign body (food) in the respiratory tract;
respiratory tract infection with weakened immunity: inflammation in the nose, larynx, trachea, bronchi and lungs due to the penetration of pathogenic viruses and bacteria;
allergic reactions due to the specific microflora of the room: dust, animal hair and other aggressive agents;
exposure to a side effect of drugs to lower blood pressure with concomitant disorders of the cardiovascular system after a stroke (for example, Magnecard can cause bronchospasm);
development of pneumonia with prolonged absence of physical activity.

It is important to understand that stagnation of blood in the pulmonary (lesser) circulation will develop pneumonia. Lying for a long time without moving reduces the amplitude of oscillation of the chest during inhalation and exhalation. Therefore, at first there will be no full breath and the supply of oxygen to the body will decrease. Then the patient will not be able to fully exhale air and remove the accumulation of carbon dioxide, dust particles, mucus and microorganisms from the lungs. In older people, pneumonia develops very quickly.

As for the antibiotic Augmentin, only your attending physician can prescribe or cancel it. Perhaps he will prescribe another antibiotic: intravenous infusion of cephalosporins: Claforan or Fortum. May prescribe injections of Ceftriaxone with Lidocaine (1%). If pneumonia takes on an infectious-inflammatory form, then Sumammed is prescribed in tablets (500 mg for 3 days), powder or lyophilisate.

Macrolides are often prescribed: Erythromycin, Azithromycin, etc. If the cough causes pain, anti-inflammatory drugs are administered intramuscularly: Diclofenac or Ibuprofen. For dry cough, treatment is prescribed with Gerbion, Libexin, Stoptusin, etc. The patient may need artificial ventilation and oxygen therapy (oxygen therapy), as well as to strengthen the immune system - tinctures of ginseng, aralia, Rhodiola rosea, Eleutherococcus extract, vitamins.

To alleviate the patient’s condition and restore motor activity and relieve cough, it is necessary:

Ventilate the room regularly 2-3 times a day;
carry out sanitation of the oral cavity;
create mobility for the patient: turn, place an additional pillow under the back;
massage the chest to prevent congestion in the lungs and bronchi;
massage the patient’s body to activate blood circulation and prevent bedsores;
develop the paralyzed side of the body and massage to restore motor function.

In consultation with your doctor, you can give expectorant decoctions for strokes and coughs from plants such as elecampane, speedwell, tricolor violet, primrose (primrose), sweet clover, dewdrop, blue lily. The following plants have anti-inflammatory and bronchodilator effects: oregano and St. John's wort, wild rosemary, calendula, peppermint, chamomile, coltsfoot, eucalyptus and sage. And also: plantain, horseradish, meadowsweet, thyme, fennel and motherwort.

It is useful to give a decoction of dark raisins after a stroke and when pneumonia develops: after crushing in a blender, raisins (0.5 tbsp.) are poured with boiling water (1 tbsp.) and placed in a bathhouse under a lid for 10 minutes. You should give 1.5 glasses per day.

Relieves the symptoms of pneumonia with fig milk: 1 tbsp. milk you will need 3 dried figs. The mixture is placed on low heat and simmered for half an hour. Give patients 2 tbsp. per day.

To improve breathing during pneumonia and cough, increase bronchial patency and lung capacity, aromatic oils of eucalyptus and rosemary are suitable. To strengthen the immune system - oils of geranium, fern, myrtle, lemon, chlorophytum. The following oils can be used as an antiseptic: sage, anise or eucalyptus, mustard, lavender or clove, mint and cypress, fir and cedar, pine and cinnamon, lemon, rosemary and thyme. When your mother can do inhalations, then add 10 drops of antiseptic oils to 1 liter of hot water.