Symptoms and treatment of pneumonia. Differential signs of pneumonia. What is nosocomial pneumonia

Pneumonia is an acute infectious and inflammatory disease with focal lesions of the respiratory sections of the lungs, intraalveolar exudation, severe febrile reaction and intoxication.

Classification of pneumonia

1. Community-Acquired Pneumonia Develops at home and is the most common form of pneumonia. Its causative agents are often pneumococci, streptococci, Haemophilus influenzae and other gram-positive microorganisms.
2. Nosocomial pneumonia (synonyms: hospital-acquired, nosocomial). It develops during the patient's stay in the hospital for another disease, but not earlier than 48-72 hours after hospitalization or 48 hours after discharge from the hospital.
3. Aspiration pneumonia occurs in patients with impaired consciousness (stroke, eclampsia attack, traumatic brain injury), as well as in the aspiration of food, vomit, foreign bodies, in violation of the cough reflex.
4. Pneumonia in persons with severe immunity defects (congenital immunodeficiency, HIV infection).

By clinical and morphological course of pneumonia:

1. Lobar (croupous) pneumonia is characterized by damage to an entire lobe (less often a segment) of the lung with involvement of the pleura in the inflammatory process;

1. acute onset with severe clinical manifestations
2. fibrinous nature of the exudate
3. damage to the alveolar tissue and respiratory bronchioles with preservation of airway patency
4. staging in the development of inflammation

2. Focal pneumonia (bronchopneumonia) is characterized by damage to the lobule or segment of the lung;

1. gradual onset and less pronounced clinical manifestations;
2. serous or mucopurulent nature of the exudate;
3. violation of the patency of the respiratory tract;
4. there is no staging in the development of inflammation.
   

The severity of pneumonia is determined by the severity of clinical manifestations, and according to this, they distinguish:

1.Mild severity

Body temperature up to 38°C, respiratory rate (RR) up to 25 per minute, heart rate (HR) up to 90 per minute, mild intoxication and cyanosis, no complications and decompensation of concomitant diseases.

2.Medium severity

Body temperature - 38-39°C, respiratory rate 25-30 per minute, heart rate 90-100 per minute, tendency to arterial hypotension, moderate intoxication and cyanosis, presence of complications (pleurisy), decompensation of concomitant diseases unexpressed.

3. Severe severity

Body temperature above 39°C, respiratory rate> 30 per minute, heart rate> 100 per minute, pronounced intoxication and cyanosis, blood pressure system.<90 мм рт. ст, АД диаст. <60 мм рт.ст., наличие осложнений (эмпиема, инфекционно-токсический шок, токсический отек легких и др.), выраженная деком-пенсация сопутствующих заболеваний.

community-acquired pneumonia

Etiology (causes of pneumonia)

The etiology of pneumonia is associated with the typical microflora that colonizes the upper respiratory tract, but only some of them, with increased virulence, are capable of causing an inflammatory response when they enter the lower respiratory tract.

Typical bacterial pathogens of pneumonia:

• pneumococcus Streptococcus pneumoniae
• hemophilic bacillus Haemophilus influenzae.

Rare bacterial pathogens

• Staphylococcus aureus aureus;
• Klebsiella and E. coli Klebsiella pneumoniae, Escherichiacoli and other members of the Enterobacteriaceae family;
• Pseudomonas aeruginosa Pseudomonas aeruginosa.

Atypical bacterial pathogens:

• mycoplasma Mycoplasma pneumoniae;
• chlamydia Chlamydia pneumoniae;
• Legionella Legionella pneumophila.
  

Thus, the cause of the development of pneumonia is associated with the microflora of the upper respiratory tract, the composition of which depends on the environment in which the person is located, his age and general health. Predisposing factors for the disease of pneumonia are childhood, elderly and senile age, background bronchopulmonary diseases (bronchitis, bronchial asthma, COPD, etc.), pathology of the ENT organs, previous pneumonia, smoking, etc. Contributing factors to the disease of pneumonia include Xia exposure to cold, chest trauma, anesthesia, alcohol intoxication, drug addiction, surgery, etc.

The pathogenesis of pneumonia

There are four pathogenetic mechanisms that cause the development of pneumonia:

1. Aspiration of the contents of the oropharynx is the main route of infection of the respiratory sections of the lungs, and hence the main pathogenetic mechanism for the development of pneumonia.
2. Inhalation of microbial aerosol
3. Hematogenous spread of the pathogen from the extrapulmonarysource of infection (tricuspid valve endocarditis, septicpelvic endocarditis)
4. Direct spread of the pathogen from neighboring affectedorgans (liver abscess, mediastinitis) or as a result of infectionfor penetrating chest wounds.

Symptoms of Community Acquired Pneumonia

Symptoms of community-acquired pneumonia depend on the etiology of the process, the age of the patient, the severity of the disease, and the presence of concomitant pathology. The most significant causative agents of pneumonia are:

• pneumococcal pneumonia

The most common causative agent of community-acquired pneumonia for all age groups is pneumococcus (30-50% of cases). Pneumococcal pneumonia usually manifests itself in two classical variants: lobar (croupous) pneumonia and focal (bronchopneumonia).

The disease usually begins acutely with fever, chills, cough with scanty sputum, often with severe pleural pain. The cough is unproductive at first, however, soon a typical “rusty” sputum appears, sometimes with an admixture of blood.

On physical examination, there is dullness of the pulmonary sound, bronchial breathing, crepitus, moist fine bubbling rales, pleural rub.

The most common complications are parapneumonic pleurisy, acute respiratory and vascular insufficiency.

• streptococcal pneumonia

The causative agent is β-hemolytic streptococcus, and the disease often develops after a viral infection (measles, influenza, etc.), has a severe course and is often complicated by sepsis. It is characterized by high fever with large daily fluctuations, repeated chills and sweats, stabbing pain in the side on the side of the lesion, streaks of blood appear in the sputum. In the feverish period, polyarthralgia is often noted.

Typical complications of this pneumonia are exudative pleurisy (70% of patients) and abscess formation. Lethality reaches 54%.

• Staphylococcal pneumonia

It is caused by Staphylococcus aureus and is often associated with influenza A and B epidemics and other respiratory viral infections.

This pathogen is characterized by peribronchial lesions with the development of single or multiple lung abscesses.

The disease begins acutely, proceeds with severe symptoms of intoxication, fever, repeated chills, shortness of breath, cough with purulent sputum. Pneumonia is usually multifocal, the development of new foci, as a rule, is accompanied by another rise in temperature and chills. With subpleural localization of the abscess, it can drain into the pleural cavity with the formation of pyopneumothorax.

• Viral pneumonia

It is most often caused by influenza viruses A and B, parainfluenza, adenoviruses. Pneumonia is distinguished by pathogenetic features - the inflammatory process begins with a pronounced edema of the bronchial mucosa, peribronchial space and alveoli, and is also complicated by the development of thrombosis, necrosis and bleeding. The disease begins with fever, chills, myalgia, conjunctivitis, sore throat and dry cough. With the development of pneumonia, shortness of breath, separation of purulent-hemorrhagic sputum, are added to the usual symptoms of influenza. Confusion of consciousness up to delirium often develops. Primary viral pneumonia from the 3-5th day from the onset of the disease becomes viral-bacterial. Auscultation in the lungs is characterized by alternating foci of hard or weakened breathing, dry rales with foci of crepitus, moist rales.

Also observed:

Pneumonia caused by Haemophilus influenzae

Klebsiella pneumonia (Friedlander's pneumonia)

Mycoplasma pneumonia

Hemorrhagic pneumonia.

Physical methods for diagnosing pneumonia

Pneumonia should be suspected if the patient has a fever associated with cough, dyspnea, sputum production, and/or chest pain. At the same time, an atypical onset of pneumonia is possible, when the patient complains of unmotivated weakness, fatigue, heavy sweating at night. In elderly patients, with concomitant pathology, in drug addicts, against the background of alcohol intoxication, extrapulmonary symptoms (drowsiness, confusion, anxiety, disruption of the sleep and wake cycle, loss of appetite, nausea, vomiting, signs of decompensation of chronic diseases of the internal organ -nov) often prevail over bronchopulmonary.

Lobar (croupous) pneumonia - symptoms

The information obtained during the physical examination of the patient depends on the severity of the disease, the prevalence of inflammation, age, concomitant diseases and, above all, on the morphological stage of development of lobar pneumonia.

High tide stage (1-2 days) characterized by severe chills, high body temperature (39-40 ° C), shortness of breath, increasing symptoms of intoxication, chest pain associated with breathing, the appearance of a dry, painful cough. On examination, the patient lies on his back or sore side, pressing his hands on the area of ​​\u200b\u200bthe chest, where the pain is most pronounced. This position somewhat reduces chest excursion and pain. The skin is hot, there is a feverish blush on the cheeks, acrocyanosis, redness of the sclera of the eyes, more on the side of the lesion. If lobar inflammation of the lung is accompanied by a viral infection, then herpetic eruptions are noted on the lips, wings of the nose and earlobes. In severe pneumonia, cyanosis of the lips, tip of the nose, and earlobes is noted, which is associated with an increase in respiratory failure and impaired hemodynamics.

There is a lagging of the diseased side of the chest in the act of breathing, although the symmetry of the chest is still preserved. On palpation, local soreness of the chest is determined, associated with inflammation of the parietal pleura, a slight increase in voice trembling and bronchophony on the side of the lesion due to compaction of the lung tissue. With percussion, there is a dullness (shortening) of percussion sound with a tympanic tint.

During auscultation, weakened vesicular breathing and crepitus are heard in the projection of the affected lobe of the lung. In the initial stage of lobar pneumonia, the alveoli only partially retain their airiness, the inner surface of their walls and bronchioles is lined with viscous fibrinous (inflammatory) exudate, and the walls themselves are edematous and rigid. During most of the inhalation, the alveoli and bronchioles are in a collapsed state, which explains the weakening of vesicular respiration. To straighten the sticky walls of the alveoli, a higher pressure gradient in the pleural cavity and upper respiratory tract is required than normal, and this is achieved only by the end of inspiration. During this period, the walls of the alveoli containing exudate come apart, and a specific sound arises - initial crepitus (crepitatioindux). In terms of sound, it resembles moist, finely bubbling rales, but differs in that it occurs only at the height of a deep breath and does not change when coughing.

Hepatization stage (5-10 days - the height of the disease)characterized by the persistence of high fever, symptoms of intoxication, the appearance of a cough with the separation of "rusty" and mucopurulent sputum, an increase in signs of respiratory and sometimes cardiovascular insufficiency. On examination, for several days from the onset of the disease, the forced position of the patient on the sore side may persist, associated with the involvement of the pleura in the inflammatory process, as well as facial hyperemia and redness of the sclera on the side of the lesion. With a severe degree of pneumonia, cyanosis increases due to an increase in ventilation respiratory failure. Breathing is frequent (25-30 or more in 1 minute) and superficial. When two or more lobes of the lung are involved in the process - tachypnea, shortness of breath of the inspiratory type (difficulty inhaling), participation in the act of breathing of auxiliary muscles, swelling of the wings of the nose, etc. There is a distinct lag in the act of breathing of the diseased half of the chest. Voice trembling and bronchophony are increased on the side of the lesion. With percussion - a pronounced dullness of percussion sound over the affected area. On auscultation, weakened vesicular breathing is replaced by hard, bronchial breathing, crepitus is not heard. Within a few days, a pleural friction noise is heard over the affected area.

Resolution stage (from the 10th day) in an uncomplicated course of pneumonia, it is characterized by a decrease in body temperature, a decrease in symptoms of general intoxication, cough, and respiratory failure. Percussion - dullness of percussion sound with a tympanic tinge, which is gradually replaced by a clear pulmonary sound. On auscultation, there is weakened vesicular breathing and at the end of inspiration, when the alveoli and bronchioles “stick apart”, final crepitus (crepitatioredux) is heard. As the exudate is removed from the alveoli and the swelling of their walls disappears, the elasticity and airiness of the lung tissue is restored, vesicular breathing is heard over the lungs, crepitus disappears.

Focal pneumonia (bronchopneumonia) - symptoms

It has a less acute and prolonged onset. Often occurs as a complication of acute respiratory viral infections, acute or exacerbation of chronic bronchitis. Within a few days, the patient notes an increase in body temperature to 37.5-38.5 ° C, runny nose, malaise, weakness, cough with mucous or mucopurulent sputum. Against this background, it is difficult to diagnose bronchopneumonia, but the lack of effect from treatment, the increase in intoxication, the appearance of shortness of breath, tachycardia speaks in favor of focal pneumonia. Gradually, the patient's cough and separation of mucopurulent or purulent sputum increase, weakness and headache increase, appetite decreases, body temperature rises to 38-39 ° C. On examination, there is hyperemia of the cheeks, cyanosis of the lips, the skin is moist. Sometimes there is pallor of the skin, which is explained by severe intoxication and a reflex increase in the tone of peripheral vessels. The chest on the side of the lesion only slightly lags behind in the act of breathing. With percussion, dullness of percussion sound is noted above the lesion, but with a small focus of inflammation or its deep location, percussion of the lungs is not informative. During auscultation, a pronounced weakening of vesicular respiration is heard over the affected area, due to a violation of bronchial patency and the presence of many microatelectases in the inflammation focus. The most reliable auscultatory sign of focal pneumonia is the auscultation of sonorous moist small bubbling rales over the affected area throughout the entire breath. These wheezing are due to the presence of inflammatory exudate in the airways. When the pleura is involved in the inflammatory process, a pleural friction rub is heard.

Thus, the most significant clinical signs that make it possible to distinguish focal bronchopneumonia from lobar (croupous) pneumonia are:

• The gradual onset of the disease, which develops, as a rule, against the background of acute respiratory viral infections or exacerbation of chronic bronchitis.
• Cough with mucopurulent sputum.
• Absence of acute pleural pain in the chest.
• Absence of bronchial breathing.
• The presence of moist sonorous small bubbling rales.

Diagnosis of pneumonia

Based on the patient's complaints, anamnesis data and physical examination methods.

In a general blood test, leukocytosis is detected, blood biochemistry can determine an increase in liver enzymes, creatinine, urea, and changes in the electrolyte composition. Microscopic examination of sputum and blood serology allow to verify the causative agent of pneumonia.

Instrumental methods: x-ray examination of the lungs in two projections. Evaluate the presence of infiltration, pleural effusion, destruction cavities, the nature of the darkening: focal, confluent, segmental, lobar or total.

Differential diagnosis of pneumonia

The main nosologies that require differential diagnosis with pneumonia are the following:

• Acute respiratory viral infections (ARVI)
• Intercostal neuralgia
• Pulmonary tuberculosis
• Acute diseases of the abdominal organs
• Acute cerebrovascular accident (ACV)
• Acute myocardial infarction
• Pulmonary embolism (PE)
  

• Acute respiratory viral infections

The absence of seasonality in pneumonia (which is more typical for ARVI), the presence of a fever that exceeds that in ARVI, the results of a physical examination obtained with careful percussion and auscultation - a shortening of the percussion sound, foci of crepitus and / or moist fine bubbling rales.

• Intercostal neuralgia

The misdiagnosis of "intercostal neuralgia" is one of the most common causes of underdiagnosis of pneumonia. For the correct diagnosis of pneumonia, it is important to take into account the peculiarities of the pain syndrome: if with pneumonia, pain is usually associated with breathing and coughing, then with intercostal neuralgia, it increases with rotation of the torso, hand movements. Palpation of the chest revealed areas of skin hyperalgesia.

• Pulmonary tuberculosis

To verify the diagnosis of tuberculosis, it is necessary, first of all, to use well-known diagnostic methods, such as anamnestic data (the patient has a history of tuberculosis of any localization, information about past diseases, such as exudative pleurisy, prolonged low-grade fever of unknown origin, inexplicable malaise, profuse sweating at night, weight loss, prolonged cough with hemoptysis). Of diagnostic value are such physical data as the localization of pathological percussion sounds and auscultatory data in the upper sections of the lungs.

The leading role in the diagnosis of tuberculosis belongs to X-ray methods of research, incl. CT, MRI, microbiological research.

• Lung cancer, lung metastases

Of great importance in the diagnosis of lung cancer are anamnestic data (smoking, work with carcinogenic substances, such as heavy metals, chemical dyes, radioactive substances, etc.). In the clinical picture of lung cancer, there is a persistent cough, a change in the timbre of the voice, the appearance of blood in the sputum, weight loss, lack of appetite, weakness, chest pain. Final verification of the diagnosis is possible on the basis of sputum examination for atypical cells, pleural exudate, tomography and / or CT of the lungs, diagnostic bronchoscopy with a biopsy of the bronchial mucosa.

• Congestive heart failure

In patients with left ventricular failure, which is a complication of coronary artery disease, arterial hypertension, heart disease, cardiomyopathy, asthma attacks usually occur at night. Patients wake up with a painful hacking cough and a feeling of suffocation. At the same time, bilateral moist rales are heard, mainly over the lower parts of the lungs. A simple technique allows to differentiate the origin of wheezing: the patient is offered to lie on his side and auscultation is repeated after 2-3 minutes. If at the same time the number of wheezing decreases over the overlying sections of the lungs and, on the contrary, increases over the underlying ones, then with a greater degree of probability these wheezing are caused by congestive heart failure. In acute pulmonary pathology, ECG signs are noted: P-pulmonale (overload of the right atrium); blockade of the right leg of the bundle of Giss; high R waves in the right chest leads. Acute diseases of the abdominal organs When pneumonia is localized in the lower parts of the lungs, the pain syndrome often spreads to the upper parts of the abdomen. The severity of abdominal pain, sometimes combined with other gastrointestinal disorders (nausea, vomiting, dyspepsia), often causes erroneous diagnosis in patients with pneumonia, acute diseases of the abdominal organs (cholecystitis, perforated ulcer, acute pancreatitis, impaired intestinal motility). In such cases, the diagnosis of pneumonia is helped by the absence of tension in the abdominal muscles and symptoms of peritoneal irritation in patients.

• Acute cerebrovascular accident (ACV)

Symptoms of CNS depression - drowsiness, lethargy, confusion, up to stupor, developed with severe pneumonia, can cause erroneous diagnosis of stroke and hospitalization of patients in the neurological department. At the same time, when examining such patients, as a rule, there are no symptoms characteristic of stroke, such as paresis, paralysis, pathological reflexes, and the reaction of the pupils is not disturbed.

• Acute myocardial infarction

With left-sided localization of pneumonia, especially in patients with involvement in the inflammatory process of the pleura, a pronounced pain syndrome may develop, which can lead to an erroneous diagnosis of "Acute myocardial infarction". To differentiate pleural pain, it is important to assess its relationship with breathing: pleural pain intensifies on inspiration. To reduce pain, patients often take a forced position on their side, on the side of the lesion, which reduces the depth of breathing. In addition, the coronary genesis of pain is usually confirmed by characteristic changes in the electrocardiogram.

• Pulmonary embolism (PE)

The acute onset of the disease, observed in particular in pneumococcal pneumonia, is also characteristic of thromboembolism in the pulmonary artery system (PE): shortness of breath, dyspnea, cyanosis, pleural pain, tachycardia and arterial hypotension up to collapse. However, along with severe shortness of breath and cyanosis in PE, swelling and pulsation of the jugular veins are observed, the boundaries of the heart shift outwards from the right edge of the sternum, pulsation often appears in the epigastric region, accent and bifurcation of the II tone above the pulmonary artery, gallop rhythm. Symptoms of right ventricular failure appear - the liver enlarges, its palpation becomes painful. On the ECG - signs of overload: right atrium: P - pulmonale in leads II, III, AVF; right ventricle: McGin-White sign or SI-QIII syndrome.

Complications of pneumonia

Diagnostic and therapeutic management of patients with community-acquired pneumonia is determined by the presence or absence of complications. Common complications include:

• Acute respiratory failure
• Pleurisy
• Broncho-obstructive syndrome
• Acute respiratory distress syndrome (non-cardiogenic pulmonary edema)
• Infectious-toxic shock

Acute respiratory failure (ARF)

This is one of the main manifestations of the severity of pneumonia and can develop from the first hours from the onset of the disease in 60-85% of patients with severe pneumonia, and more than half of them need mechanical ventilation. The severe course of pneumonia is accompanied by the development of a predominantly parenchymal (hypoxemic) form of respiratory failure. The clinical picture of ARF is characterized by a rapid increase in symptoms and involvement in the pathological process of vital organs - the central nervous system, heart, kidneys, gastrointestinal tract, liver and the lungs themselves. Among the first clinical signs is shortness of breath, while rapid breathing (tachypnea) is accompanied by a growing feeling of respiratory discomfort (dyspnea). As ARF increases, a pronounced tension of the respiratory muscles is noticeable, which is fraught with its fatigue and the development of hypercapnia. The increase in arterial hypoxemia is accompanied by the development of diffuse cyanosis, reflecting a rapid increase in the content of unsaturated hemoglobin in the blood. In severe cases, with SaO2 values<90%, цианоз приобретает сероватый оттенок. Кожа при этом становится холодной, часто покрывается липким потом. При тяжелой дыхательной недостаточности важно оценить динамику выраженности цианоза под влиянием оксигенотерапии - отсутствие изменений свиде-тельствует о паренхиматозном характере ОДН, в основе которой лежат выраженные вентиляционно-перфузионные расстройства. Отрица-тельная реакция на ингаляцию кислорода указывает на необходимость перевода больного, на искусственную вентиляцию легких (ИВЛ). ОДН при пневмонии на начальных стадиях сопровождается тахикардией, отра-жающей компенсаторную интенсификацию кровообращения. С раз-витием декомпенсации и дыхательного ацидоза нередко развивается брадикардия - весьма неблагоприятный признак, сопровождающийся высоким риском летального исхода. При тяжелой дыхательной недостаточности нарастает гипоксия ЦНС. Больные становятся беспокойными, возбужденными, а по мере прогрессирования ОДН развивается угнетение сознания и кома.

Treatment. It is necessary to ensure normal gas exchange in the lungs with the achievement of Sa02 above 90%, and PaO2> 70-75 mm Hg. and normalization of cardiac output and hemodynamics. To improve oxygenation, oxygen inhalation is performed, and if oxygen therapy is not effective enough, respiratory support in the ventilator mode is indicated. In order to normalize hemodynamics, infusion therapy is carried out with the addition of glucocorticoid hormones and vasopressor amines (dopamine).

Pleurisy

Pleurisy is one of the frequent complications of community-acquired pneumonia and more than 40% of pneumonias are accompanied by pleural effusion, and with massive accumulation of fluid, it acquires a leading role in the clinic of the disease. The onset of the disease is characterized by the appearance of acute intense pain in the chest associated with breathing. Shortness of breath often takes on the character of suffocation. At the first stages of fluid accumulation, paroxysmal dry ("pleural") cough may be noted. On examination - restriction of respiratory movements, the intercostal spaces are wider, the lagging of the affected half of the chest in the act of breathing. During percussion - above the effusion zone, the percussion sound is shortened, and the upper limit of dullness has a characteristic arc-shaped curve (Damuazo line), weakening of voice trembling. On auscultation - weakened vesicular breathing. With a significant amount of fluid in the lower parts of the pleural cavity, respiratory noises are not carried out, and in the upper (in the zone of lung collapse) breathing sometimes acquires a bronchial character. Percussion can reveal signs of mediastinal displacement in the opposite direction, which is confirmed by a change in the boundaries of cardiac dullness.

Treatment. For the relief of pleural pain and inflammation in pneumonia, non-steroidal anti-inflammatory drugs, in particular, lornoxicam, are indicated.

Broncho-obstructive syndrome

This syndrome is typical for patients with community-acquired pneumonia that developed against the background of chronic obstructive pulmonary disease (COPD).

The main symptoms of broncho-obstructive syndrome:

• Cough - persistent or aggravated periodically, as a rule, productive;
• Shortness of breath, the severity of which depends on the severity of inflammation of the lungs and the severity of bronchial obstruction.

On auscultation, dry whistling rales are heard over the entire surface of the lungs against the background of an extended exhalation. Wet rales, as a rule, are limited to the zone of inflammatory infiltration. The severity of bronchial obstruction is detected by assessing exhalation, which is much longer than inhalation, as well as using expiratory tests. The study of the function of external respiration, in particular, a simple technique of peak flowmetry, allows you to determine the degree of severity of obstructive ventilation disorders.

Treatment. Berodual is an effective means of eliminating broncho-obstructive syndrome in patients with pneumonia. Berodual can be used both in the form of metered aerosols and in the form of solutions through a nebulizer - at a dose of 1-2 ml (20-40 drops) in a dilution of sodium chloride 0.9% - 3 ml. Patients in whom edema of the bronchial mucosa predominates in the pathogenesis of broncho-obstructive syndrome, which is especially characteristic of COPD, a good result is achieved by combined therapy through a nebulizer: 20-25 drops of berodual in combination with corticosteroid budesonide (pulmicort) at a starting dose of 0.25 -0.5mg. In the absence or insufficient effectiveness of inhalation drugs, it is possible to use theophyllines, in particular, intravenous administration of 5-10 ml of a 2.4% solution of aminophylline slowly, as well as intravenous injections of prednisolone 60-120 mg. All noted measures to eliminate bronchial obstruction should be assessed by dynamic control of the results of peak flowmetry. Carrying out oxygen therapy has a positive effect on lung function and hemodynamics of the pulmonary circulation (high pressure in the pulmonary artery decreases), however, caution is needed in patients with COPD, because. inhalation of high concentrations of oxygen in the inhaled air is fraught with the development of hypercapnic coma and respiratory arrest. In such patients, the recommended concentration of oxygen in the inhaled air is 28-30%. The result of oxygen therapy is evaluated by pulse oximetry. It is necessary to achieve an increase in Sa 02 more than 92%.

Acute vascular insufficiency (collapse)

Patients complain of a severe headache, general weakness, dizziness, aggravated by a change in body position. In the supine position, a decrease in systolic blood pressure to a level of less than 90 mm Hg is usually determined. Art. or a decrease in the patient's usual systolic blood pressure by more than 40 mm Hg. Art., and diastolic blood pressure less than 60 mm Hg. Art. When trying to sit or stand, such patients may experience severe fainting. Vascular insufficiency in pneumonia is caused by dilatation of peripheral vessels and a decrease in BCC due to the transfer of fluid from the vascular bed to the extracellular space. Emergency care for arterial hypotension begins with giving the patient a position with the head lowered and the foot end raised. In severe pneumonia and arterial hypotension (BP<90/60 мм рт.ст.) необходимо восполнение потери жидкости: у больных с ли-хорадкой при повышении температуры тела на 1°С количество жидко-сти в организме уменьшается на 500 мл /сутки.

Treatment. Jet intravenous drip injection of 0.9% sodium chloride solution 400 ml or 5% glucose solution 400 ml. Prior to the normalization of blood pressure, antipyretic drugs should not be prescribed, as this can lead to aggravation of arterial hypotension. With persistent arterial hypotension - but only after replenishing the BCC, the use of vasopressor amines is indicated until systolic blood pressure reaches 90 - 100 mm Hg. Art.: 200 mg of dopamine diluted in 400 ml of 0.9% sodium chloride solution or 5% glucose solution and injected intravenously at a rate of 5-10 mcg / kg per minute. Drop infusion cannot be stopped abruptly, a gradual decrease in the rate of administration is necessary. To eliminate the increased permeability of the vascular endothelium, glucocorticoid hormones are used - prednisolone at an initial dose of 60-90 mg (up to 300 mg) intravenously in a stream.

Acute respiratory distress syndrome (ARDS, non-cardiogenic pulmonary edema)

ARDS most often develops within the first 1-3 days of the onset of pneumonia. In the acute exudative phase of ARDS, the patient is disturbed by excruciating shortness of breath, dry cough, discomfort in the chest, and palpitations. After a while, shortness of breath intensifies and turns into suffocation. If the exudate penetrates into the alveoli (alveolar pulmonary edema), suffocation intensifies, a cough appears with frothy sputum, sometimes pinkish in color. On examination, the patient is agitated, takes a forced semi-sitting position (orthopnea). Diffuse, gray cyanosis appears and rapidly increases, due to a progressive impairment of oxygenation in the lungs. The skin is moist, the body temperature is elevated. Breathing, regardless of the genesis of ARDS, is accelerated, auxiliary muscles are involved in the act of breathing, for example, retraction during inspiration of the intercostal spaces and supraclavicular fossae, swelling of the wings of the nose. Percussion - there is a slight shortening of the percussion sound in the posterior-lower chest. On auscultation, in the same place, against the background of weakened breathing, crepitus is heard symmetrically on both sides, and then a large number of moist, finely and medium bubbling rales that spread to the entire surface of the chest. In contrast to the auscultatory manifestations of pneumonia, rales in ARDS are heard diffusely in symmetrical areas of the lungs on both sides. In severe cases of alveolar pulmonary edema, noisy breathing and coarse, moist rales audible at a distance (bubbling breathing) appear. Heart sounds are muffled, heart rate is 110-120 in 1 min. Arterial pressure is reduced, the pulse is rapid, may be arrhythmic, small filling. In the terminal stage of acute respiratory distress syndrome, signs of multiple organ failure may appear due to the effect of systemic inflammation on the internal organs, and the functions of the kidneys, liver, and brain are impaired. Pulmonary edema that develops with pneumonia is one of the non-cardiogenic pulmonary edema. At the same time, transcapillary filtration increases not due to an increase in hydrostatic pressure, but mainly due to increased vascular permeability. The accumulated fluid and protein in the interstitial tissue enter the alveoli, which leads to an increasing deterioration in the diffusion of oxygen and carbon dioxide. As a result, patients develop signs of acute respiratory distress syndrome. The main clinical manifestations of pulmonary edema in pneumonia are cough and shortness of breath. In contrast to cardiogenic pulmonary edema, shortness of breath in patients with ARDS develops into a feeling of suffocation. During auscultation, moist rales are heard over the entire surface of the lungs, oxygen saturation drops sharply (Sa02< 90%), нарастает ар-териальная гипотензия. Интенсивная терапия направлена на нормализацию повышенной проницаемости альвеоло-капиллярной мембраны и улучшение газо-обмена. Для устранения высокой проницаемости стенки капилляров легких и блокирования мембраноповреждающих факторов воспале-ния (интерлейкины, фактор некроза опухоли и др.) применяют глюкокортикоидные гормоны - преднизолон внутривенно болюсно 90-120 мг (до 300 мг) или метилпреднизолон из расчета 0,5-1 мг/кг (суточная доза 10-20 мг/кг массы тела). Важным элементом патогенетической терапии ОРДС при пневмонии является адекватная оксигенотерапия, которую начинают с ингаляции 100% увлажненного кислорода через носовой катетер 6-10 л/мин. При отсутствии эффекта и нарастании гипоксемии необходимо перевести больного на искусственную вентиляцию легких. В настоящее время считается нецелесообразным увеличение до-ставки кислорода к тканям у больных с острым респираторным дистресс-синдромом с помощью инотропных аминов (дофамин). Исключение составляют случаи, где имеются признаки сердечной недостаточности, и снижение сердечного выбро-са связано не с развитием гиповолемии, а с падением сократительной способности сердечной мышцы.

Infectious-toxic shock

The number of patients with severe pneumonia, complicated by infectious-toxic shock, can reach 10%. Most often, infectious-toxic shock is caused by gram-negative flora, while mortality reaches 90%. The so-called "cold" or "pale" shock develops, which is based on the high permeability of the vascular wall, and a massive exit of the liquid part of the blood into the interstitial space with a sharp decrease in BCC. The second component of "cold" shock is widespread peripheral vasospasm. Clinically, this type of shock is characterized by an extremely serious condition with impaired consciousness, pallor of the skin, a thready pulse, and a decrease in blood pressure below critical values. In one third of patients, shock is the result of exposure to the body of gram-positive flora, while mortality is 50-60%. Such patients develop the so-called "warm shock" with peripheral vasodilation, blood deposition, and decreased venous return to the heart. Clinically, this variant of shock is also manifested by arterial hypotension, however, the skin is warm, dry, and cyanotic. Thus, as a result of the impact of pneumonia pathogens on the vascular system, hypovolemic shock develops, characterized by a decrease in BCC, cardiac output, CVP (pressure in the right atrium) and filling pressure of the left ventricle. In severe cases, if the toxic effect of microorganisms continues, hypoxia of organs and tissues, aggravated by respiratory failure and hypoxemia, leads to the development of fatal microcirculation disorders, metabolic acidosis, DIC, and a sharp impairment of vascular permeability and the function of peripheral organs.

On examination - a sharp pallor of the skin and visible mucous membranes, acrocyanosis, the skin is wet and cold. When examining patients, characteristic signs of shock are revealed:

tachypnea;

Progressive hypoxemia (Sa02< 90%);

Tachycardia >120 beats per minute, thready pulse;

Reducing systolic blood pressure to 90 mm Hg. Art. and below;

A significant decrease in pulse blood pressure (up to 15-20 mm Hg);

Deafness of heart sounds;

Oliguria.

In severe cases, stupor and even coma may develop. Cold, moist, pale skin acquires an earthy-gray hue, which is an indicator of a pronounced violation of peripheral circulation. Body temperature drops below 36°C, shortness of breath increases, respiratory rate increases to 30-35 in 1 min. The pulse is threadlike, frequent, sometimes arrhythmic. Heart sounds are muffled. Systolic blood pressure is not higher than 60-50 mm Hg. Art. or not defined at all. Intensive care is a complex of urgent measures, the algorithm of which depends on the type and severity of shock. First of all, it is important to start antibiotic therapy in a timely manner, using drugs with the widest spectrum of action - ceftriaxone 1.0 g. intravenously diluted with 10 ml of 0.9% sodium chloride solution. Due to the high frequency of hypoxemic respiratory failure, patients with infectious-toxic shock usually need respiratory support - non-invasive mechanical ventilation with oxygen therapy, and with the development of tachypnea (respiratory rate above 30/min.), tracheal intubation and mechanical ventilation should be planned. In order to block the systemic inflammatory response, glucocorticoid hormones are used - prednisolone at the rate of 2-5 mg / kg of body weight intravenously by stream. Infusion therapy involves the intravenous administration of saline solutions, such as chlosol, acesol, trisol 400 ml intravenously with dopamine 200 mg under the control of blood pressure. Free radical oxidation of lipids and proteins, expressed in infectious-toxic shock, requires increased antioxidant protection. For this purpose, it is recommended to administer ascorbic acid at the rate of 0.3 ml of a 5% solution per 10 kg of body weight intravenously.

Treatment of uncomplicated pneumonia

Uncomplicated community-acquired pneumonia can be treated on an outpatient basis, under the supervision of polyclinic doctors. However, in recent years, patients with any form of pneumonia are trying to be hospitalized in a hospital.

Bed rest is necessary in the first days of the disease, diet therapy is easily digestible, with a sufficient amount of vitamins and free fluid, carbohydrate restriction. Antipyretics are prescribed with a significant increase in temperature, which violates the general condition of the patient. At body temperature up to 38 ° in patients without severe comorbidity, the appointment of antipyretics is not justified. With concomitant bronchitis - the appointment of expectorants, bronchodilators. Breathing exercises.

Etiotropic therapy of pneumonia consists in antibiotic therapy. Amoxiclav or antibiotics from the groups of macrolides and cephalosporins are prescribed. The duration of treatment is usually 10-14 days.

Despite the fact that pneumonia has been well studied as a pathology, diagnostic methods have improved, the identification of pathogens has become effective, and the treatment of the disease has become effective. from which patients massively died earlier, nevertheless, the disease is widespread and sometimes manifests itself in complex forms.

According to statistics in Russia, about 400 thousand people fall ill with pneumonia every year, given the fact that patients go to the hospital already with an acute form of the disease, it is worth assuming that approximately the same number of citizens suffer pneumonia “on their feet”.

Pneumonia most often affects the lower respiratory tract.

Is an infectious disease therefore, not only the patient, but also the people around at work, at home, in public transport can be at risk.

The inflammatory focus affects the following components:

1. Bronchi.
2. Bronchioles.
3. Alveoli.
4. Lung parenchyma.

Influence factors.

The age of the patient. Over the years, immunity is steadily weakening, so it is easier for pathogenic microorganisms to enter the human body. Older people are at greater risk than young and middle-aged people. Children of infants, infants, preschool and early school age are at high risk, since their immunity is not fully formed.

Smoking- one of the factors that reduces the body's ability to fully resist viruses, bacteria. Resins and nicotine destroy the barrier function of the epithelium of the bronchi and alveoli, which means that it is easier for microorganisms to penetrate into the lungs and develop in a favorable environment.

Alcohol- Ethyl alcohol is recognized as a toxic substance, poison. Once in the blood, it destroys leukocytes and other antibodies that can counteract pneumonia pathogens. In addition, alcohol is excreted from the body not only through the genitourinary system, but also through the lungs, damaging the respiratory mucosa.

Other causes of the development of the disease

Other factors, such as congenital and acquired abnormalities, also provoke the development of pneumonia.

The main types of pneumonia

Pneumonia- a disease that can be caused by various types of pathogens. Depending on the causes and pathogens, the very nature of the course of the disease is formed.

Nosocomial pneumonia occurs in public organizations (hospitals, clinics, educational institutions), where the pathogen circulates. The classic pathogen are staphylococci, viruses, streptococci that affect the lung tissue. It takes 3 days for the first symptoms of nosocominal pneumonia to appear.

Aspiratory pneumonia. Causative agents get with food, water and other products that have cysts of microorganisms or viral particles that provoke the disease.
Community-acquired form - obtained as a result of contact with infected children, animals at home or on the street.

Immunodeficiency inflammation of the lungs. The focus has long been in the lungs, but was in a dormant state. After a decrease in immunity, pathogens intensify their activity, creating favorable conditions for their development, affecting the lung tissues.

SARS is a form of the disease, the causes of which may differ from those described above.

Features of the disease

The disease can develop with the active development of bacterial, viral and fungal pathogens in the lungs. Depending on the cause of the occurrence, pulmonologists prescribe the most effective treatment.

Pathogens are bacterial

Bacteria are more likely than other organisms to infect the lungs. The causes that provoke inflammation are the following groups of bacteria:

• pneumococci;
• staphylococci;
• streptococci;
• hemophilic bacillus;
• moraxella.

These are the most common pathogens. But really. The causes of occurrence can be very diverse. Almost any bacterium that enters the lungs can, under favorable conditions, create inflammatory foci in the lung tissue. Pneumonia often occurs under the influence of various viruses.

Both in children and adults, the causes that provoke pneumonia can be intracellular organisms (chlamydia, legionella, other microorganisms). Pneumonia, which occurs when these pathogens multiply rapidly, proceeds relatively easily.

Viral pathogens

Viral pathogens affect the lung tissue in 90% of cases in children, only in 10% of a hundred in adults. Viral pneumonia occurs under the influence of measles, chicken pox, cytomegalovirus viruses, and manifests itself if the patient's immunity drops sharply.

Unlike bacterial pneumonia, viral pneumonia has a seasonality, and activity is observed in the cold season.

Fungal pathogens

Fungal microorganisms rarely affect the lungs. The reason for their rapid development in the lungs with tissue damage can only be immunodeficiency. In fact, saprophytes are found in humans in the oral cavity, GI tract, and on the skin. When immunity drops to a critical level, these microorganisms penetrate the lungs and develop there.

An inflammatory focus in the lungs also occurs when bacteria and viruses are combined, then it is more difficult to establish the cause of the disease, and pneumonia takes on a complex form.

Depending on the cause and factor of occurrence, the form of the disease will also depend. If the disease is provoked by the influenza virus, then the inflammation will be more difficult than when exposed to adenoviruses. This is due to the fact that the influenza virus causes intoxication of the body as a whole.

- an acute lesion of the lungs of an infectious-inflammatory nature, which involves all the structural elements of the lung tissue, mainly the alveoli and interstitial tissue of the lungs. The clinic of pneumonia is characterized by fever, weakness, sweating, chest pain, shortness of breath, cough with sputum (mucous, purulent, "rusty"). Pneumonia is diagnosed on the basis of an auscultatory picture, X-ray data of the lungs. In the acute period, treatment includes antibiotic therapy, detoxification therapy, immunostimulation; taking mucolytics, expectorants, antihistamines; after the cessation of fever - physiotherapy, exercise therapy.

ICD-10

J18 Pneumonia without specification of the causative agent

General information

Pneumonia is an inflammation of the lower respiratory tract of various etiologies, occurring with intraalveolar exudation and accompanied by characteristic clinical and radiological signs. Acute pneumonia occurs in 10-14 people out of 1000, in the age group over 50 years old - in 17 people out of 1000. The urgency of the problem of the incidence of acute pneumonia remains, despite the introduction of new antimicrobial drugs, as well as a high percentage of complications and mortality (up to 9% ) from pneumonia. Among the causes of death of the population, pneumonia is in 4th place after diseases of the heart and blood vessels, malignant neoplasms, traumatism and poisoning. Pneumonia can develop in debilitated patients, joining the course of heart failure, oncological diseases, cerebrovascular accidents, and complicates the outcome of the latter. In AIDS patients, pneumonia is the leading direct cause of death.

Causes and mechanism of development of pneumonia

Among the causes of pneumonia, bacterial infection is in the first place. The most common causative agents of pneumonia are:

• gram-positive microorganisms: pneumococci (from 40 to 60%), staphylococci (from 2 to 5%), streptococci (2.5%);
• Gram-negative microorganisms: Friedlander's bacillus (from 3 to 8%), Haemophilus influenzae (7%), Enterobacteriaceae (6%), Proteus, Escherichia coli, Legionella, etc. (from 1.5 to 4.5%);
• viral infections (herpes, influenza and parainfluenza viruses, adenoviruses, etc.);

Also, pneumonia can develop due to exposure to non-infectious factors: chest injuries, ionizing radiation, toxic substances, allergic agents.

The risk group for the development of pneumonia includes patients with congestive heart failure, chronic bronchitis, chronic nasopharyngeal infection, congenital malformations of the lungs, with severe immunodeficiency, debilitated and malnourished patients, patients who are on bed rest for a long time, as well as elderly and senile people .

People who smoke and abuse alcohol are especially susceptible to the development of pneumonia. Nicotine and alcohol vapor damage the bronchial mucosa and inhibit the protective factors of the bronchopulmonary system, creating a favorable environment for the introduction and reproduction of infection.

Infectious pathogens of pneumonia penetrate the lungs through bronchogenic, hematogenous or lymphogenous routes. With the existing decrease in the protective bronchopulmonary barrier in the alveoli, infectious inflammation develops, which spreads through the permeable interalveolar septa to other parts of the lung tissue. In the alveoli, exudate is formed, which prevents the gas exchange of oxygen between the lung tissue and blood vessels. Oxygen and respiratory insufficiency develops, and with a complicated course of pneumonia - heart failure.

There are 4 stages in the development of pneumonia:

• the stage of the tide (from 12 hours to 3 days) is characterized by a sharp blood filling of the vessels of the lungs and fibrinous exudation in the alveoli;
• stage of red hepatization (from 1 to 3 days) - lung tissue is compacted, resembling a liver in structure. In the alveolar exudate, erythrocytes are found in large numbers;
• the stage of gray hepatization - (from 2 to 6 days) - is characterized by the breakdown of erythrocytes and a massive release of leukocytes into the alveoli;
• resolution stage - the normal structure of the lung tissue is restored.

Classification of pneumonia

1. Based on epidemiological data, pneumonia is distinguished:

• out-of-hospital (out-of-hospital)
• nosocomial (hospital)
• caused by immunodeficiency conditions

2. According to the etiological factor, with the specification of the pathogen, pneumonia can be:

• mycoplasma
• fungal
• mixed.

3. According to the mechanism of development, pneumonia is isolated:

• primary, developing as an independent pathology
• secondary, developing as a complication of concomitant diseases (for example, congestive pneumonia)
• aspiration, developing when foreign bodies enter the bronchi (food particles, vomit, etc.)
• post-traumatic
• postoperative
• pneumonia infarctiondeveloping as a result of thromboembolism of small vascular branches of the pulmonary artery.

4. According to the degree of interest of the lung tissue, pneumonia occurs:

• unilateral (with damage to the right or left lung)
• bilateral
• total, lobar, segmental, sublobular, basal (central).

5. By the nature of the course of pneumonia can be:

• sharp
• acute lingering
• chronic

6. Taking into account the development of functional disorders of pneumonia, the following occur:

• with the presence of functional disorders (indicating their characteristics and severity)
• with no functional impairment.

7. Taking into account the development of complications of pneumonia, there are:

• uncomplicated course
• complicated course (pleurisy, abscess, bacterial toxic shock, myocarditis, endocarditis, etc.).

8. On the basis of clinical and morphological features, pneumonia is distinguished:

• parenchymal (croupous or lobar)
• focal (bronchopneumonia, lobular pneumonia)
• interstitial (more often with mycoplasmal lesions).

9. Depending on the severity of the course of pneumonia, they are divided into:

• mild degree - characterized by mild intoxication (clear consciousness, body temperature up to 38 ° C, blood pressure is normal, tachycardia is not more than 90 beats per minute), there is no shortness of breath at rest, a small focus of inflammation is determined radiologically.
• moderate degree - signs of moderately severe intoxication (clear consciousness, sweating, severe weakness, body temperature up to 39 ° C, blood pressure moderately reduced, tachycardia about 100 beats per minute), respiratory rate - up to 30 per minute. at rest, the expressed infiltration is defined radiologically.
• severe degree - characterized by severe intoxication (fever 39-40 ° C, clouding of the creation, adynamia, delirium, tachycardia over 100 beats per minute, collapse), shortness of breath up to 40 beats per minute. at rest, cyanosis, radiographically determined extensive infiltration, the development of complications of pneumonia.

Symptoms of pneumonia

Croupous pneumonia

Characterized by an acute onset with fever over 39 ° C, chills, chest pain, shortness of breath, weakness. Worried about the cough: at first dry, unproductive, then, for 3-4 days - with "rusty" sputum. Body temperature is constantly high. With lobar pneumonia, fever, cough and sputum discharge last up to 10 days.

In severe cases of croupous pneumonia, hyperemia of the skin and cyanosis of the nasolabial triangle are determined. Herpetic eruptions are visible on the lips, cheeks, chin, wings of the nose. The patient's condition is serious. Breathing is shallow, rapid, with swelling of the wings of the nose. Crepitus and moist small bubbling rales are auscultated. Pulse, frequent, often arrhythmic, blood pressure is reduced, heart sounds are muffled.

Focal pneumonia

It is characterized by a gradual, inconspicuous onset, more often after acute respiratory viral infections or acute tracheobronchitis. The body temperature is febrile (38-38.5 ° C) with daily fluctuations, cough is accompanied by discharge of mucopurulent sputum, sweating, weakness are noted, when breathing - pain in the chest on inspiration and coughing, acrocyanosis. With focal confluent pneumonia, the patient's condition worsens: severe shortness of breath, cyanosis appear.

On auscultation, hard breathing is heard, the exhalation is lengthened, dry fine and medium bubbling rales, crepitus over the focus of inflammation.

Features of the course of pneumonia are due to the severity, the properties of the pathogen and the presence of complications.

Complications of pneumonia

Complicated is the course of pneumonia, accompanied by the development in the bronchopulmonary system and other organs of inflammatory and reactive processes caused directly by inflammation of the lungs. The course and outcome of pneumonia largely depends on the presence of complications. Complications of pneumonia can be pulmonary and extrapulmonary.

Pulmonary complications in pneumonia can be obstructive syndrome, abscess, lung gangrene, acute respiratory failure, parapneumonic exudative pleurisy.

Among the extrapulmonary complications of pneumonia, acute cardiopulmonary failure, endocarditis, myocarditis, meningitis and meningoencephalitis, glomerulonephritis, toxic shock, anemia, psychosis, etc. often develop.

Diagnosis of pneumonia

When diagnosing pneumonia, several tasks are solved at once: differential diagnosis of inflammation with other pulmonary processes, clarification of the etiology and severity (complications) of pneumonia. Pneumonia in a patient should be suspected on the basis of symptomatic signs: rapid development of fever and intoxication, cough.

On physical examination, lung tissue compaction is determined (based on percussion dullness of pulmonary sound and increased bronchophony), a characteristic auscultatory picture - focal, moist, finely bubbling, sonorous rales or crepitus. With echocardiography and ultrasound of the pleural cavity, a pleural effusion is sometimes determined.

As a rule, the diagnosis of pneumonia is confirmed after a lung x-ray. With any type of pneumonia, the process often captures the lower lobes of the lung. On radiographs with pneumonia, the following changes can be detected:

• parenchymal (focal or diffuse blackouts of various localization and extent);
• interstitial (pulmonary pattern is enhanced by perivascular and peribronchial infiltration).

X-rays for pneumonia are usually taken at the onset of the disease and after 3-4 weeks to monitor the resolution of inflammation and exclude other pathology (often bronchogenic lung cancer). Changes in the general blood test in pneumonia are characterized by leukocytosis from 15 to 30 109 / l, a stab shift of the leukocyte formula from 6 to 30%, an increase in ESR to 30-50 mm / h. In the general analysis of urine, proteinuria can be determined, less often microhematuria. A sputum bacteriological analysis for pneumonia allows you to identify the pathogen and determine its sensitivity to antibiotics.

Treatment of pneumonia

Patients with pneumonia are usually hospitalized in a general therapeutic department or a pulmonology department. For the period of fever and intoxication, bed rest, plentiful warm drink, high-calorie, vitamin-rich food are prescribed. With severe symptoms of respiratory failure, patients with pneumonia are prescribed oxygen inhalations.

The main treatment for pneumonia is antibiotic therapy. Antibiotics should be prescribed as early as possible, without waiting for the identification of the pathogen. The selection of an antibiotic is carried out by a doctor, no self-treatment is unacceptable! With community-acquired pneumonia, penicillins (amoxicillin with clavulanic acid, ampicillin, etc.), macrolides (spiramycin, roxithromycin), cephalosporins (cefazolin, etc.) are more often prescribed. The choice of the method of administration of the antibiotic is determined by the severity of the course of pneumonia. For the treatment of nosocomial pneumonia, penicillins, cephalosporins, fluoroquinolones (ciprofloxacin, ofloxacin, etc.), carbapenems (imipenem), aminoglycosides (gentamicin) are used. With an unknown pathogen, a combined antibiotic therapy of 2-3 drugs is prescribed. The course of treatment can last from 7-10 to 14 days, it is possible to change the antibiotic.

With pneumonia, detoxification therapy, immunostimulation, the appointment of antipyretic, expectorant and mucolytic, antihistamines are indicated. After the cessation of fever and intoxication, the regimen is expanded and physiotherapy is prescribed (electrophoresis with calcium chloride, potassium iodide, hyaluronidase, UHF, massage, inhalation) and exercise therapy to stimulate the resolution of the inflammatory focus.

Treatment of pneumonia is carried out until the patient's complete recovery, which is determined by the normalization of the condition and well-being, physical, radiological and laboratory parameters. With frequent repeated pneumonia of the same localization, the issue of surgical intervention is decided.

Pneumonia prognosis

In pneumonia, the prognosis is determined by a number of factors: the virulence of the pathogen, the age of the patient, background diseases, immune reactivity, and the adequacy of treatment. Complicated variants of the course of pneumonia, immunodeficiency states, resistance of pathogens to antibiotic therapy are unfavorable in relation to the prognosis. Especially dangerous is pneumonia in children under 1 year old, caused by staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella: their mortality rate is from 10 to 30%.

With timely and adequate therapeutic measures, pneumonia ends in recovery. According to the variants of changes in the lung tissue, the following outcomes of pneumonia can be observed:

• complete restoration of the lung tissue structure - 70%;
• formation of a site of local pneumosclerosis - 20%;
• formation of a local carnification site – 7%;
• decrease in segment or share in size - 2%;
• wrinkling of a segment or share - 1%.

Prevention of pneumonia

Measures to prevent the development of pneumonia are to harden the body, maintain immunity, eliminate the hypothermia factor, sanitize chronic infectious foci of the nasopharynx, combat dust, stop smoking and alcohol abuse. In debilitated bedridden patients, in order to prevent pneumonia, it is advisable to conduct respiratory and therapeutic exercises, massage, and prescribe antiplatelet agents (pentoxifylline, heparin).

Pneumonia or pneumonia is a very dangerous pathology that combines a whole complex of diseases into a single ailment. All of them are quite similar, as they provoke the development of an inflammatory process in human lung tissues.

Only timely and properly organized therapy of pneumonia can guarantee that no complications will follow. Remember, this pathology not only negatively affects the human body, but often causes death.

Regardless of the complete etiology of pneumonia, the cause of its appearance and further development is the same - infection in the alveoli and bronchial epithelium of a person. No one is immune from such a phenomenon, because the causative agent of pneumonia can get into the respiratory tract of any person.

Of course, pneumonia does not always develop due to the transmission of infection by airborne droplets, however, a similar phenomenon takes place in a considerable number of infection situations.

Often, pneumonia develops due to the early presence in the human body of some infection, which caused the development of a non-serious ENT disease, which gave such an unpleasant complication.

Predisposition factors for the development of pneumonia are such things as:

• general hypothermia of the body
• frequent nervous stress
• hormonal problems
• presence of chronic respiratory disease
• weakening of the immune system

It should be understood that there are a huge number of infections that can cause pneumonia (these are bacteria, viruses, and fungi). It is simply impossible to fully protect yourself from them, but it is necessary to maintain the state of the body in good shape.

Remember, the weaker the body and its immunity, the more likely it is to “catch” pneumonia. This is especially true for adults, who often lead a far from normal life, sleep at the wrong time and generally abuse the resources of the body.

First signs

As mentioned earlier, pneumonia is a pathology that causes damage to the tissues of the lungs and some other nodes of the respiratory system. Due to the developing inflammatory process, a person simply cannot feel well and some symptoms of pneumonia appear.

Diagnosis of symptoms is necessary in the early stages of the disease, as this will help to avoid any complications and generally simplify the treatment process.

First of all, you should pay attention to the following signs indicating pneumonia:

• intensifying and often recurring of absolutely any character
• raising the body in different limits
• severe feverish state
• the appearance of shortness of breath
• feeling short of breath
• severe weakness, drowsiness and fatigue
• increased hoarseness and loudness of breathing

Depending on the type of infection that caused the inflammation, the symptoms can be both pronounced and quite weak. In any case, you should pay attention to it and immediately contact the clinic for help. ATIt is important not to forget that pneumonia has a short incubation period (2-4 days), after which it develops at an increased rate and can cause irreparable damage to the health of the patient or even cause death.

Inflammation of the lungs is a complex of diseases affecting the respiratory tract. That is why it is divided into some forms, determined by the degree of damage and the severity of the course of the disease. Determination of the correct characteristics of the inflammatory process is extremely important for the organization of proper therapy.

At the moment, medical workers distinguish 4 main forms of pneumonia in adults:

1. A disease that occurs with an acute type of inflammation. With timely treatment, it is relatively not dangerous for a person, but in its absence it can cause a number of complications. This form of pneumonia can develop as an independent disease, or be a consequence of complications of other respiratory diseases.
2. A disease that occurs with a chronic type of inflammation. This form is characterized by the constant presence of infection in the tissues of the lungs and other organs of the respiratory system. The disease is activated systematically, often with a weakened immune system or the presence of other factors predisposing to pneumonia. It is quite rare, but it is an extremely dangerous disease, especially in the absence of timely and competent therapy.
3. A disease that occurs with an acute type of inflammation that affects most of the lung. Otherwise, this form is called croupous. It is one of the most dangerous forms of pneumonia, therefore, it requires treatment only under the supervision of an experienced specialist. A similar form of pathology occurs due to poor-quality or long-absent therapy for acute or chronic pneumonia.
4. A disease that occurs with a segmental (focal) inflammatory process. This form differs from others in that the inflammation affects separate segments of the lungs and airways. This type of pneumonia, although not so dangerous, should be treated in a timely manner, otherwise it can flow into more severe forms of the disease.

Without special medical knowledge, a series of examinations and analyzes, it is simply impossible to determine the form of inflammation. However, know: the stronger the symptoms of the disease, the more dangerous its form. It is possible to treat a complex type of pneumonia only in a clinic, otherwise the risk of death increases significantly.

Diagnostic methods

Diagnosis of pneumonia solely by analyzing the symptoms is not possible, therefore, if there is any suspicion of the development of pneumonia, it is important for a person to immediately visit a doctor.

The complexity of the diagnostic measures of pneumonia lies in the fact that this pathology often has the same symptoms as those of less serious respiratory ailments. At the same time, developing, pneumonia can cause much more problems than other ENT diseases.

Given this danger of the disease, doctors must include the following procedures in the diagnosis:

• blood, urine and sputum tests
• chest x-ray
• fibrobronchoscopy and computed tomography of the chest

Only based on the result of several diagnostic measures and the nuances of each specific case, the doctor can determine with certainty whether the patient has pneumonia or some other ailment develops.

Self-diagnosis of pneumonia is not only impossible, but also extremely dangerous, because by starting to treat the disease incorrectly, you can accelerate its development or provoke the appearance of complications.

Medical treatment

Since pneumonia in adults is a rather dangerous disease, medications are the basis of its treatment without fail. Their appointment should be dealt with by the attending physician, because only he knows the features of a particular case.

Moreover, it is the specialist who, based on the results of the tests, can find out what type of infection is the causative agent of pneumonia, based on this indicator, the main vector of therapy is determined.

Regardless of the etiology of pneumonia, the main principle of its treatment is the organization of complex therapy, which is aimed at stopping the inflammatory process in the respiratory tract and improving the general tone of the patient's body.

It is important in the treatment of pneumonia to use the following types of drugs:

• antibiotics (for bacterial pathogens)
• antiviral drugs (for a viral pathogen)
• antifungal medicines (for a fungal pathogen)
• expectorants (for problems with sputum expectoration and severe coughing)
• detoxification and glucocorticosteroid agents (in the presence of toxic shock caused by pathology)
• antipyretic drugs (with fever)
• cardiovascular stimulants (with oxygen starvation and severe shortness of breath)
• vitamin complexes and immunostimulants (for any course of the disease)

More information about pneumonia can be found in the video:

It should be understood that self-treatment of pneumonia will not work. First of all, this is due to the fact that the dosage of drugs and the course of therapy is determined solely by the doctor, taking into account all the features of each specific case.

In addition to the main medications, the attending specialist may prescribe:

• oxygen therapy (with oxygen starvation and severe shortness of breath)
• artificial respiration therapy (with oxygen starvation and severe shortness of breath)
• inhalation techniques (for problems with sputum expectoration and severe coughing)
• extremely rare - surgical methods of treatment (for serious lung damage)

Folk recipes

It must be remembered that folk methods are additional in the treatment of pneumonia.

Folk methods of treating pneumonia are by no means the basis of treatment. These methods of treating an ailment can only be used as an aid to the main, medical course.

Folk recipes cannot stop or in any way stop inflammation of the lungs, but they perfectly help in combating the unpleasant symptoms of pathology and in increasing the immune tone of the body of a sick person.

The most interesting, effective and often used folk remedies for pneumonia are:

• Curd compress. Cooking method: take 100 grams of cottage cheese and mix it with a teaspoon of honey, heat the resulting mixture and put it in gauze in a thin layer, then roll it into several layers. Application: apply the gauze with the mixture wrapped in it to the patient's chest, then securely fasten the compress with a terry towel over your shoulder and leave it for 4-8 hours.
• Purification of the lungs from sputum with honey and nuts. Cooking method: take 50 grams of any nuts and honey, chop the first and mix with the second ingredient into a single mixture. Application: the resulting mixture must be eaten by the patient within one day, used until complete recovery. Contraindications: Allergy to the components of the product.
• Softening with milk and figs. Method of preparation: heat one glass of unpasteurized milk and mix it with finely shredded figs. Application: the resulting solution should be drunk to the patient twice a day after meals. Contraindications: Allergy to the components of the product and fever.
• Steam inhalation. Cooking method: take 3-4 large potatoes and boil them with their skins in 2-3 liters of water, after boiling, turn off the gas and add 10-20 drops of eucalyptus oil to the water. Application: put the patient in front of this liquid and cover him with a terry towel, he should inhale the steam for 10-20 minutes, the procedure is repeated daily, once a day. Contraindications: allergy to the components of the product, fever and the presence of purulent inflammation in the respiratory tract.
• Vitamin teas. Method of preparation: brew tea and add honey, jam, dried fruits and similar products to it, which will saturate the drink with vitamins. Application: the patient should drink such teas throughout the course of therapy and as often as possible. Contraindications: Allergy to the components of the product.

Do not forget, before using this or that folk method of treating pneumonia, ask your doctor if this practice is appropriate in your particular case.

What not to do with pneumonia

Given the danger of pneumonia, it is important not to forget about those things that can cause any complications in the treatment of this disease.

It is most important to exclude from your life the following list of actions for the period of treatment of pneumonia:

1. smoking
2. consumption of alcoholic beverages
3. any physical and emotional stress (pneumonia can only be treated with bed rest)
4. in the presence of temperature - taking a bath, shower or walking
5. bath or sauna visit
6. eating cold drinks, fatty foods, spicy and too salty foods.

Possible Complications

As noted earlier, pneumonia is dangerous not only for its course, but also for the complications that it can cause. The appearance of complications is rare in the implementation of high-quality and timely therapy of the disease, however, with its low quality or the complete absence of complications, it is only a matter of time.

The most common of them are the following:

• destruction of lung tissue
• obstruction
• pathological pathologies of the respiratory system
• heart problems
• development of pathologies of the spinal cord or brain
• septic shock
• cardiogenic edema or sepsis
• blockage of blood vessels in the chest area

It should be understood that the presence of a number of complications can cause death. Therefore, it is important to treat pneumonia competently and in a timely manner.

To treat pneumonia, of course, is not easy, but possible.

However, is it worth it? Isn't it easier to just prevent the development of the disease? Of course, no one and no one can fully guarantee protection against pneumonia, but you can reduce the risk of its development several times if you follow simple preventive measures.

The general list of those is as follows:

• Eliminate hypothermia of the body.
• Regularly carry out hardening.
• Treat all respiratory diseases completely and promptly.
• Periodically do special breathing exercises.
• Vaccinate against especially dangerous infections.
• Minimize the inhalation of harmful fumes and dust.
• Try to lead a normal lifestyle: exercise, healthy eating, sleep, and so on.

The most serious thinking about the prevention of pneumonia is for those people who are at risk. These include everyone who is affected in one way or another by the previously mentioned factors of predisposition to this pathology.

In general, identifying the first signs of pneumonia in adults and starting to treat the disease is quite simple. The main thing is to follow the advice from the material presented above. We hope that in today's article you have found answers to your questions. Health to you!

Inflammation of the lungs is a very serious disease, which in medicine is officially called pneumonia. The disease ranks 4th in mortality after strokes, heart attacks and oncology. The most pressing question today is what is pneumonia, is it possible to get infected from this disease and at what stage? To have an idea about the danger of the disease, you need to know about the causes of the pathological process and the nuances of its development.

Pneumonia - what is it

The main essence of the disease is that the lung tissue undergoes pathological changes. Respiratory function suffers from inflammatory processes and, as a result, all organs and tissues, as they receive less oxygen. Inflammation of the lungs is an infectious disease during which viruses and microbes attack the alveoli - the smallest particles of the respiratory apparatus. Pneumonia can affect a small area of ​​lung tissue or spread to the entire lung. The disease develops in a week, and full recovery can take several months.

pathogens

Inflammation of the lungs proceeds, depending on the pathogen that caused it. More often (up to 50%) pathology causes pneumococcus. This group includes more than 100 types of bacteria. The most common are mycoplasma (mycoplasmal pneumonia), legionella, chlamydia. In second place in frequency, the lung tissue is affected by Haemophilus influenzae, Staphylococcus aureus, Klebsiella and other microbes. An epidemic outbreak is caused by aggressive pathogens that spread through the air. Epidemics of pneumococcal pneumonia occur in crowded places.

Is pneumonia contagious?

Before finding out whether pneumonia is contagious, you should understand what caused the disease. If bacterial pneumonia has occurred in a person against the background of an already existing pathology, then this is unlikely to cause an infection in a partner who has been in contact with the patient. However, if atypical microorganisms (chlamydia, mycoplasma, and others) have become pathogens, they are often transmitted by airborne droplets. If another person has lowered immunity, then the risk of infection is very high. For this reason, it is better to keep contact with the patient to a minimum.

Symptoms

What is pneumonia, it is not always possible to immediately understand, because the clinical symptoms of the disease are very diverse, and the manifestation of the pathology depends on numerous factors. The initial complaints of the patient are similar to the signs of many bacterial infections: weakness, fever, malaise, excessive sweating, high body temperature. Then there is a cough with discharge of purulent sputum, pain in the chest cavity, respiratory failure. When the pathogen enters the lung tissue through the bloodstream, the doctor additionally reveals the following clinical symptoms:

• shortening of percussion sound;
• pleural friction noise;
• moist small bubbling rales;
• crepitus;
• weakened bronchial breathing;
• weakening of voice trembling.

Causes of pneumonia

You can get pneumonia in many ways, because there are a lot of reasons why pneumonia happens. As already mentioned, the pneumococcus bacterium is in the first place. Often the causative agents are:

• gram-positive microorganisms: streptococci, staphylococci;
• Gram-negative microorganisms: Haemophilus influenzae, Enterobacteria, Friedlander's bacillus, Legionella, Proteus, Escherichia coli;
• mycoplasmas;
• fungal infections;
• viral infections (adenoviruses, parainfluenza, influenza, herpes).

The disease provokes not only the infectious agent of pneumonia. Often, pneumonia begins due to non-infectious factors: allergic agents, toxic substances, ionizing radiation, chest injuries. The risk group includes patients with:

• chronic bronchitis;
• congestive heart failure;
• congenital malformations of the lungs;
• chronic nasopharyngeal infections;
• severe immunodeficiency states.

What is dangerous

What is pneumonia, already figured out. However, not all patients treat treatment with due attention, because they do not know why pneumonia is dangerous. Before the invention of antibiotics, the disease was fatal. The disease is still fatal in 5% of cases. Pneumonia is especially dangerous for children and elderly patients, since their immunity is weakened. Immediately after the defeat of the bronchi and lungs, a violation of oxygen metabolism occurs. Consequences for adult patients may be the following:

• respiratory failure;
• bronchial asthma;
• heart failure;
• fibrosis or lung abscess.

During pregnancy

Pneumonia of viral etiology is dangerous for both mother and child. The problem is that in the early stages, the symptoms of alveolar damage are similar to the clinical manifestations of a cold, so women do not go to doctors, trying to be treated on their own. Such behavior only exacerbates the pathology. If aspiration pneumonia was detected on time, then the prognosis is favorable. If home treatment has led to the addition of a secondary infection or to a purulent complication, then the risk of severe consequences is high. Inflammation of the lungs during pregnancy can lead to:

• myocarditis, endocarditis;
• infectious-toxic shock;
• sepsis;
• respiratory failure;
• broncho-obstructive syndrome;
• exudative pleurisy;
• edema, abscess, gangrene of the lung.

In childhood

Among children, infants and schoolchildren are more likely to get pneumonia. With untimely treatment of pathology, the consequences for the child's body can be very different: pleurisy, destructive pneumonitis, cardiopulmonary failure. If the correct therapy is carried out, then there should be no consequences and complications, and the prognosis of the disease in most cases is positive.

Classification

Depending on the severity of the disease and the characteristic symptoms, several types of pneumonia are distinguished:

1. Typical. The main cause is focal infectious inflammation.
2. atypical pathogen. It is the cause of a whole group of diseases, the symptoms of which vary in each case. With progressive development, lobar inflammation can be observed. On x-rays, this type of inflammation is not clear, therefore it is considered very insidious.
3. A stagnant look. It is characterized by the occurrence of stagnation in the bronchi. The accumulation of sputum causes the development of pathogenic microbes, which provokes first respiratory viral diseases, and then a chronic infection (chlamydial pneumonia).
4. Entry of alien masses. More often we are talking about small objects or food particles that cause damage to the mucous membrane.

stages

With the development of viral pneumonia, doctors distinguish several stages of the course of the disease:

1. Tidal stage. The duration is about 80 hours. It is characterized by a sharp flow of blood into the lungs with the release of exudate. There is swelling of the organ, which leads to its inflammation.
2. Red hepatization stage. Duration is no more than 70 hours. The lung tissues thicken, increase in volume, the concentration of red blood cells in the exudate increases.
3. The stage of gray hepatization. In the exudate, erythrocytes disappear, the content of leukocytes increases. This leads to the fact that the lung tissue becomes gray. The period can last one week.
4. Resolution stage. There is a resorption of fibrin, the breakdown of leukocytes, as a result, the lung acquires a healthy appearance. The duration of recovery is 10-12 days.

Diagnostics

To confirm the possible pathology of the lungs, laboratory and instrumental diagnostic methods are used. The main method is X-ray in direct and lateral projection. For a clearer definition of the focus of inflammation (especially with segmental pneumonia), the following are additionally used:

• CT scan;
• electrocardiography;
• fibrobronchoscopy;
• lung biopsy (for interstitial pneumonia);
• examination of the function of external respiration (if shortness of breath is observed).

Laboratory studies include a complete blood count, sputum examination and bacterioscopy. In a severe course of the disease with characteristic lung lesions, blood is taken from a vein to determine the pathogen. If the pathology is accompanied by flu-like symptoms, a blood test is taken for antibodies to viruses. In severe focal pneumonia, a complete study of blood gases is necessary for the timely start of artificial lung ventilation.

Auscultation

Diagnosis of lobar pneumonia includes auscultation. The doctor carefully listens to the lungs, paying special attention to the patient's breathing. Auscultatory symptoms:

1. Moist fine bubbling rales. They are heard during inspiration at maximum airflow rate. The symptom occurs when a viscous exudate is formed in the bronchi, consisting of bubbles, which, passing through the air stream, burst and make a characteristic sound.
2. Crepitus. Pathological process in the alveoli, which occurs when their walls are wetted with a viscous secret. This results in an audible crackle when inhaling. When the patient tries to cough, crepitus does not disappear, which distinguishes it from wheezing.

Treatment

Therapeutic actions are aimed at suppressing an acute bacterial infection, restoring pulmonary resistance, and eliminating protracted intoxication. The main treatment for pneumonia is the appointment of antibacterial drugs. Do not prescribe antibiotics if the disease is caused by viruses. In this case, the treatment is carried out with anti-inflammatory and antiviral drugs. The presence of fungal pneumonia in a patient requires the use of antifungal drugs. To speed up the recovery of the patient, doctors additionally prescribe:

• physiotherapy exercises;
• massage;
• physiological procedures.

Preparations

In the vast majority, pneumonia is treated with antibiotics. Among the antibacterial agents, penicillins can be distinguished. Their mechanism of action is aimed at suppressing the biosynthesis of the cell membrane, which protects the cell from the surrounding space. This group of antibiotics includes:

1. Novocillin. Release form - vials for intramuscular injection. On average, 1 million units are prescribed 4 times / day.
2. Oxacillin. Available in 0.25 g, 0.5 g in vials, capsules and tablets. Apply every 4-5 hours. The average daily dose is 6 g.
3. Nafcillin. Assign intravenously or intramuscularly every 4-6 hours. The daily dose is from 6 to 12 g.

The course can range from 3 days to several weeks, depending on the severity of the disease. For nosocomial pneumonia in a hospital setting, a combined antibiotic treatment regimen is performed to eliminate the risk of an epidemic. With hospital pneumonia, especially with staphylococcal infection, the following antibacterial drugs are prescribed:

• cephalosporins 3-4 generations;
• carbapenems;
• fluoroquinolones;
• erythromycin;
• aminoglycosides.

Folk remedies

There are tips for treating pathology with folk methods. This is dangerous, especially against the background of a chronic disease, as it can be fatal, so all therapeutic measures should be discussed with a doctor. There is a herbal medicine that helps with dry cough and reduces the appearance of sputum. One of the most effective recipes is a collection of calendula flowers, St. John's wort and chamomile. To prepare a decoction, mix 1 tsp. each component, pour 2 cups of boiling water, then insist for 2 hours. Take 3 times a day for 0, 3 cups until the condition improves.

Complications of pneumonia

Basically, all pulmonary complications are associated with inadequate treatment. The worst case scenario is a fatal outcome against the background of pleural effusion, when excess fluid seeps into space. There is a risk of infection passing to nearby tissues and organs, causing a pathological process in them. It can be the heart, brain, pulmonary arteries.

How not to get pneumonia from a patient

In order not to catch an infection, you should know what pneumonia is and how you can avoid infection. To reduce the risk of disease, you should follow a few rules that will increase the overall immunity of the body:

• treat viral infections in time;
• do not overcool;
• get a flu shot every year;
• to refuse from bad habits.

Prevention

The main advice that can be given in order to prevent pneumonia is to consult a doctor when the first symptoms of a cold appear. People who suffer from chronic broncho-pulmonary diseases, in order not to get infected, should be vaccinated with PNEUMO-23. In addition, basic recommendations include:

• maintaining a positive attitude;
• maintaining an active lifestyle;
• varied food.

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