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

Reasons for the development of pneumonia after a stroke

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

There are a number of factors that lead to pneumonia:

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

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

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

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

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

The danger of pneumonia after a stroke, possible complications

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

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

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

Symptoms

Pneumonia after a stroke is characterized by the following symptoms:

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

Treatment features

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

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

The following can be assigned:

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

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

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

Forecast

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

If therapy begins on time, and the doctor selects the correct and accurate tactics, the outcome will be quite favorable.

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

Prevention

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

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

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

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

Pneumonia in bedridden patients is a typical reaction of the body to prolonged stagnation. Since a person is immobilized, while eating, particles of food or drunk liquid can enter the lungs, which subsequently becomes one of the possible causes of the disease.

Various pathogenic bacteria (pneumococci, streptococci, staphylococci, Haemophilus influenzae) also take part in the inflammatory process.

reference! As statistics show, in 15 people out of 100, the disease ends in death.

A positive result is possible with timely access to a therapist and the implementation of all the recommendations prescribed by him.

Types and causes of pneumonia

Experts identify two forms of pneumonia in bedridden.

Stagnant (hypostatic)

It occurs in people who have been bedridden for a long time. Due to the impossibility of changing position (a person spends most of the time lying on his back), blood circulation in the lungs is disturbed, as well as a violation of natural ventilation (since the chest is constantly in a static and partially compressed position).

Thus, phlegm accumulates in the lungs, which serves as a favorable environment for inflammatory processes.

After stroke (aspiration)

It occurs as a result of partial paralysis, a person has problems swallowing food, therefore food or liquid can enter the lungs, thereby blocking the lumen of the bronchi and obstructing the passage of air.

Subsequently, pathogenic microorganisms develop in this environment, which provoke pneumonia.

Oops!Both forms of the disease pose a threat to health and life, therefore they require urgent medical intervention.

So, congestive pneumonia can form under the influence of factors such as:

• Heart disease (angina pectoris, arrhythmia, cardiosclerosis, etc.).
• High blood pressure.
• Diabetes.
• Kidney disease (including pyelonephritis).
• Bone system pathologies (scoliosis of the thoracic region, deformation of the ribs, etc.).
• Lung diseases (bronchial asthma, emphysema, etc.).
• Recently transferred surgery (in any area).

The following factors are the causes of pneumonia after a stroke:

• Immobility of the body for a long time.
• Coma state.
• Heart and lung diseases (recent).
• Elderly age.
• Excess weight.
• Taking medications (H2 blockers, etc.).
• Connecting to a ventilator (over a long period of time).

Doctors believe that the second form of pneumonia (after a stroke) is diagnosed and treated much easier than congestive pneumonia.

Symptoms of the disease

The first symptoms of the disease are the following signs:

1. Severe cough (especially at night).
2. Increased salivation.
3. Decreased or lack of appetite.
4. Difficulty breathing.
5. An increase in body temperature (up to about 37 degrees).
6. Constant weakness and drowsiness.
7. Sputum does not go away (and if it is released in a small amount, it is immediately swallowed).
8. Loss of food pieces from the mouth (during chewing).

Subsequently, the symptoms worsen and the patient feels worse:

1. The temperature reaches 38-39 degrees.
2. A moist cough appears with profuse sputum (sometimes with blood).
3. There are signs of intoxication of the body (nausea, vomiting, diarrhea, fever).
4. Wheezing is heard when breathing.
5. There is pain in the abdomen.
6. Heart rate beats.
7. In some cases, headache is present.
8. Confusion of consciousness and inhibition of reactions are observed (somewhat reminiscent of alzheimer's disease).

Watch a video that explains the symptoms of pneumonia:

Treatment of the disease

Treatment of pneumonia in bedridden patients requires an integrated approach and includes the following therapy methods:

• Taking antibiotics.
• Liberation of the accumulated fluid from the lungs.
• Using diuretics (to improve circulation).
• Taking medications to separate sputum.
• Physiotherapy treatment.
• Traditional methods.

Using antibacterial agents

Before prescribing certain drugs, the patient is tested for sputum (to identify certain bacteria).

Generally list of medicines looks like this (the doctor prescribes the dosage and course of treatment):

• Azithromycin - an antibiotic that is active against both gram-positive and gram-negative bacteria. The average price is 130 rubles (6 capsules).
• Erythromycin - bacteriostatic antibiotic, which can be used in case of allergy to penicillins. Price - 90 rubles (10 tablets).
• Cefuroxime- powder for intravenous and intramuscular injections, active against a wide range of pathogenic microorganisms. The drug can be purchased at a cost of 1280 rubles (10 bottles).
• Amoxiclav- an antibiotic based on semisynthetic penicillin amoxicillin (broad-spectrum), active against Haemophilus influenzae and pneumococci. The average price is 230 rubles (15 tablets). Also, the drug is available in the form of a powder for the preparation of suspensions (for oral administration).
• Levofloxacin- a broad-spectrum antibiotic (especially active against pneumococci). Price - 340 rubles (5 tablets).

Important!If the patient's condition does not improve within 3 days, the antibiotic should be replaced. Also, do not self-medicate, since this can only aggravate the situation.

Clearing the lungs of phlegm

With a large accumulation of fluid in the lungs (if it does not come out), the patient is prescribed hardware aspiration (using a special device, sputum is pumped out). After this procedure, the person feels much better (including coughing decreases).

The video tells about the features of the course and treatment of pneumonia in the elderly:

Use of diuretics (diuretics)

To improve blood circulation in the lungs the patient is prescribed the following drugs:

1. Furosemide (an emergency diuretic). Price - 25 rubles (50 tablets).
2. Mannit (diuretic for intravenous administration). The average price is 85 rubles (for 1 bottle).
3. Lasix (diuretic in the form of tablets for oral administration). Price - 60 rubles (45 pcs.).

Drug therapy for sputum removal

For separation of accumulated sputum the following drugs are prescribed:

1. Lazolvan (fast acting expectorant). Price - 170 rubles (20 tablets).
2. Bromhexine (has an antitussive and expectorant effect). Price - 21 rubles (50 tablets).
3. Mucaltin (contains marshmallow and polysaccharides). Price - 60 rubles (20 pcs.).

Physiotherapy procedures

Pulmonary congestion can also be relieved with massage.

In addition, treatment methods such as:

• Inhalation.
• Electrophoresis.
• Magnetic laser therapy, etc.

Folk methods

As a supplement (after consultation with your doctor), you can use folk remedies.

Here is some of them:

• Horseradish inhalation - Peel and grind the root of the plant, then place 20 grams of the product in a ceramic pot. Inhale horseradish vapors for 10 minutes (up to 5-6 times a day). The remedy relieves a strong cough.
• Plantain leaf - 3 tbsp. l. chopped fresh plant mixed with 3 tbsp. l. honey. Consume 1 tbsp. l. 3-4 times a day (20 minutes before meals). The tool promotes the separation of sputum and the elimination of dry cough attacks.

Methods for treating pneumonia with folk remedies are described in the video:

Prevention

1. Change body position every 2 hours.
2. Several times a day, turn the patient on his stomach and rub the chest area with camphor alcohol.
3. Massage (in the form of light tapping).
4. Put mustard plasters at least once a week.
5. Provide the patient with warm comfortable conditions (without hypothermia).
6. Make up the right diet (including fresh vegetables and fruits, dairy products, eggs, herbs).
7. Measure body temperature, pulse and blood pressure every day. And in case of the slightest deviation, consult a doctor.

Thus, pneumonia is a serious infectious disease, which is much more difficult to tolerate in the supine position than in a normal state (since immunity decreases and the body is greatly weakened).

Therefore, such a person requires daily care and providing all comfortable conditions.

Treatment must be agreed with a doctor (including folk remedies), since there may be contraindications that aggravate the situation.

Also, do not neglect preventive measures and remember that the disease after remission can resume again.

Pneumonia after a stroke develops in almost every third patient. Moreover, the appearance of this complication significantly increases the risk of death. Therefore, it is extremely important to know how to prevent the development of pneumonia after a stroke, and if it occurs, how to effectively treat the pathology.

The main reason for the appearance of pneumonia in patients who have recently had a stroke is a significant weakening of the immune system and impaired circulation of the body. Most often, pneumonia develops in bedridden patients.

With prolonged immobility, the patient's natural drainage function is disrupted and the cough reflex decreases. In addition, the low immune defense of the body allows pathological microorganisms to actively multiply in the patient's respiratory system, destroying the normal microflora.

There are also a number of factors that contribute to the development of pneumonia after stroke:

• Age over 60;
• Being overweight;
• The patient's stay in a coma;
• Recently suffered pneumonia;
• Taking H2 blockers;
• Long-term use of a ventilator.

Previous serious respiratory or cardiovascular diseases also significantly increase the risk of developing pneumonia after a stroke.

Clinical manifestations

Common signs of developing pneumonia after a stroke are:

• Body temperature above 38.5 0 C or below 36 0 C;
• The appearance of a dry or wet cough, mainly at night;
• Frequent loss of food from the mouth during chewing;
• Separation of viscous, thick sputum, usually green;
• Dyspnea;
• When listening with a phonendoscope, wheezing is heard in the lungs;
• The occurrence of pain in the chest area.

Fever is one of the signs of pneumonia after a stroke

Signs of pneumonia that occurs after a stroke may differ, depending on the type of inflammatory process:

1. Aspiration pneumonia is characterized by a painful cough and a gradually increasing temperature. In this case, the inflammatory process begins due to small pieces of food trapped in the lumen of the lungs and blocking the work of a separate segment of the respiratory organ.
2. Congestive, or hypostatic pneumonia, is accompanied by the accumulation of phlegm in the lungs, which is not excreted naturally. Pathology develops due to circulatory disorders resulting from a long stay of the patient in a supine position.

Sometimes with pneumonia, an increase or decrease in body temperature in a patient may be insignificant or absent.

Diagnostics

To select the most effective treatment for pneumonia in a patient with a stroke, the following diagnostic measures are carried out:

• General blood analysis;
• Sputum bacteriological analysis;
• General examination using a phonendoscope;
• Radiography of the lungs.

Late diagnosis is most often caused by the similarity of the symptom of pneumonia with post-stroke manifestations. Also, an x-ray of the lungs is not always informative with the development of an inflammatory process in the posterior-basal or reed zones of the lung.

Treatment methods

Treatment of pneumonia that develops after a stroke must be comprehensive. The therapy consists of:

• Taking medications;
• Oxygen therapy;
• Conducting physiotherapy exercises (LFK);
• Massage sessions;
• Physiotherapy procedures.

During and after treatment, it is extremely important to observe all preventive measures. The main goals of therapy are to relieve swelling in the brain area, and to combat congestion in the lungs.

Medication

During the treatment of pathology, the following groups of drugs can be used:

1. Antibiotics. Used when there is a bacterial infection.
2. Diuretics They are used to ensure the timely removal of fluid from the body and prevent the development of edema in the tissues.
3. Cardiotonics. Essential for improving the functioning of the cardiovascular system, and ensuring healthy blood circulation in all tissues of the body.
4. Mucolytics. They are used to liquefy and facilitate the removal of accumulated phlegm.

Adjustment of drug therapy, when treating a patient after a stroke, is made every 3 days.

Oxygen therapy

Oxygen therapy consists in the forced supply of oxygen to the patient through a special mask, cannula tubes, or by connecting to a ventilator.

Oxygen therapy - a method of treating pneumonia after a stroke

The duration of oxygen therapy sessions is determined only by a doctor. The minimum session duration is 10 minutes. However, oxygen is not supplied to the patient in its pure form. Its healthy concentration should be 20-21%.

Exercise therapy

Physiotherapy for pneumonia, in patients after a stroke, consists in the daily conduct of special breathing exercises. For walking patients, breathing exercise is necessarily accompanied by a warm-up of the limbs and torso in the form of bends, deflections and swings.

For patients with complications in the form of partial or complete paralysis, breathing exercises are also performed. One of the simplest and most effective exercises is the patient's inflation of balloons.

Massage

When treating pneumonia, massage is performed on such areas of the body:

• Front side of the chest;
• Back;

Massage helps to improve blood circulation, and also helps to accelerate metabolic processes in the body. Thanks to a correctly performed massage, a patient with pneumonia facilitates the process of sputum waste.

Physiotherapy

When treating a patient with a stroke from pneumonia, the following physiotherapeutic measures are used:

• Inhalation;
• Electrophoresis;
• Ultrahigh-frequency chest therapy;
• Magnetic laser therapy;
• Electric sleep.

At the stage of recovery, the patient is often prescribed information-wave therapy, which is carried out using the Azor-IK apparatus. In this case, the impact should be on the interscapular region, as well as the sternum.

Possible complications

The main complications of pneumonia associated with a stroke include:

1. Respiratory dysfunction accompanied by partial or complete cessation of breathing. In such cases, the patient must be connected to a ventilator.
2. Intoxication of the body with bacteria waste products.
3. Loss of consciousness and coma. The condition most often develops with bilateral pneumonia, in which the body is not provided with sufficient oxygen.

Loss of consciousness and coma are possible complications of pneumonia after a stroke

With late diagnosis of pneumonia, death is possible.

Forecast

In general, the prognosis for a complete cure for pneumonia depends on the timely prescribed and correct treatment. In the case of aspiration lesions, it is much easier to achieve a positive result from treatment than with congestive pneumonia. In this case, complete recovery occurs in more than 40% of patients.

In elderly bedridden patients who have suffered a stroke in the event of pneumonia, the prognosis for recovery is less favorable than for patients not affected by paralysis.

Prevention measures

Prevention of the development of pneumonia in bedridden patients, after a stroke, consists in the following measures:

• Daily sanitation of the room where the patient stays;
• Regular physical therapy. The procedures should be performed at least once a day;
• Compliance with all hygiene rules;
• Use of modern tracheostomy tubes and their correct installation.

Antibiotics are not used to prevent pneumonia after a stroke. This group of drugs should be used only if there is a bacterial inflammatory process in the body. Otherwise, drugs can further reduce immunity and disrupt the functioning of the gastrointestinal tract.

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Stroke is a serious disease characterized by an acute disturbance of blood circulation in the structures of the brain. Such a violation occurs quite quickly, but the treatment and rehabilitation of patients takes a lot of time and effort, both for the patient and those caring for him. As a result of a stroke, permanent disability of patients very often appears. Unfortunately, deaths from stroke are also high. After a stroke, the patient may be immobilized for a sufficiently long period of time, or his physical activity will be minimized.

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

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

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

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

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

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

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

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

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

Symptoms and signs

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

Cough with congestive pneumonia is accompanied by symptoms such as:

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

Diagnosis - congestive pneumonia

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

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

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

Treatment for congestive pneumonia

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

• fighting bacterial infection;
• control of ventilation of the lungs;
• improved blood supply to the lungs;
• reduced swelling.

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

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

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

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

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

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

Folk remedies to help

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

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

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

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

Pneumonia, which occurs in patients with strokes, significantly worsens the patient's condition and is often fatal.

Reasons for the development of pneumonia after a stroke

Most often, bacterial pneumonia develops against the background of a stroke. In this case, 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 due to the fact that after severe strokes, patients are in a hospital.

The 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 \u200b\u200bthe brain has many chemoreceptors that respond to any change in blood gas composition.

With an increased content 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 the inhalation is carried out. 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 makes it difficult to clear mucus from the lungs. Without the control of the respiratory center, the act of breathing cannot be carried out, therefore, hemorrhagic and ischemic strokes of the brain stem are the most dangerous for the patient's life.

Pneumonia in stroke in bedridden patients occurs due to congestion in the lungs. Prolonged immobilized or simply horizontal position of the patient contributes to stagnation of blood in the pulmonary circulation. With venous congestion, the liquid part of the blood is sweated into the alveoli and its corpuscles (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 unconsciousness, which often accompanies severe strokes, vomit or gastric juice may enter the airways of patients. As a result of the aspiration of these fluids, an inflammatory process develops in the lungs.

Clinical picture and diagnosis of post-stroke pneumonia in bedridden patients

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

By 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 impaired breathing.

Late pneumonia is hypostatic and associated with stagnation of blood in the pulmonary circulation. As a rule, they arise against the background of positive dynamics of the course of stroke, therefore, the prognosis for such pneumonia is more favorable. Such a classification of pneumonia is necessary for the choice of treatment tactics for the patient.

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

• an increase in body temperature up to 38.5-39 ° С;
• 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 worsens when 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;
• violation of consciousness.

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

This leads to medical errors and delayed diagnosis. The diagnostic criteria for early pneumonia in severe stroke include:

• often, instead of hyperthermia, a decrease in body temperature below 36 ° C can be observed (this is due to damage to the center of thermoregulation 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 (it 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 the activation of a chronic infectious process in the upper respiratory tract;
• some locations of the focus of inflammation in the lungs may not be detected during a traditional X-ray examination, therefore, the X-ray must be performed several times with an interval of one day and at least in 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 tactics of treating a patient with pneumonia after a stroke depends on the patient's age, the cause and duration 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 antibiotic therapy for pneumonia, you do not need to wait for the results of bacteriological sputum tests.

Immediately after the diagnosis of pneumonia, empiric antibiotic therapy is prescribed, which can be corrected if it is ineffective after receiving the results of bacterial culture. The choice of antibiotic in this case depends on the time of occurrence of pneumonia, since the cause of such pneumonia is different pathogens:

Respiratory function of the lungs is maintained with oxygen therapy or by connecting the patient to a ventilator.

The ingress 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. Normalization of the gas composition and acid-base balance is observed in the blood, which affects all metabolic processes in the body.

Improvement of drainage function is carried out by prescribing bronchodilator, mucolytic and bronchodilator drugs (Bromhexine, Acetylcysteine, Euphyllin), but is important only when the patient breathes independently. When connecting it to a ventilator, the bronchi should be sanitized artificially (by sucking their contents).

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

The volume and duration of conservative therapy for pneumonia in 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 left untreated, the disease in 100% of cases ends fatally, since the patient's weakened immunity cannot cope with the infection on its own. If the treatment of pneumonia was started late or his tactics were wrong, the patient may develop complications.

Complications of pneumonia after strokes include:

• asbestosis of the inflammatory focus;
• gangrene of the lungs;
• exudative pleurisy;
• empyema of the lungs;
• pneumosclerosis;
• infectious toxic shock;
• multiple organ failure.

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

Prevention of pneumonia after stroke

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

Doctors who monitor patients in a hospital need to be highly alert about the development of such a life-threatening complication of a stroke as acute pneumonia.

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

In the event of the first signs of pneumonia, you must immediately consult a doctor so as not to waste precious time. The prognosis for the recovery of patients with pneumonia in stroke is significantly improved with early diagnosis and timely treatment.