Any surgical intervention can lead to the development of complications. Pneumonia after surgery is one of the most common consequences when manipulating the organs of the chest cavity. It develops during the recovery period and has a number of features. This type of complication can also occur in the case of surgical interventions on other organs, from the brain to the intestines.
Postoperative pneumonia symptoms
The clinical manifestations of postoperative pneumonia are often not very specific and require careful differential diagnosis. In the initial period of the disease, the symptoms may vary, depending on the place and nature of the operation, the individual characteristics of the human body. For example, in young patients, the defenses are at their peak, which means that the complication manifests itself, as a rule, in a mild form. But there are a number of important signs by which an experienced specialist can immediately suspect the development of a pathological inflammatory process in the lungs. Among them, the most significant are the following symptoms:
- increased body temperature, which is clearly not associated with the site of intervention;
- shortness of breath, shortness of breath;
- complaints of chest pains mainly during inhalation, possibly during exhalation;
- cough (provided that such a reaction is not characteristic of the intervention), sputum production.
To recognize pneumonia that has developed as a result of surgery, the doctor can use specially designed algorithms for medical practitioners. Timely diagnosis is extremely important, since in advanced cases, the complication can become a threat to the patient’s life.
One of the important factors contributing to the development of inflammation in the lungs after surgery is the use of anesthesia with mechanical ventilation – artificial ventilation of the lungs. With such manipulations, the conditionally pathogenic flora almost completely falls on the mucous membrane of the trachea, and its mechanical damage is possible. After that, it becomes much easier for pathogenic organisms to get to the bronchi and pulmonary alveoli, given the weakened state of the patient’s body. In this case, the infection may not penetrate into the lower respiratory tract, this requires the presence of certain conditions.
The following factors affect the likelihood of developing pneumonia after surgery:
- the patient has a history of chronic respiratory diseases;
- getting into the bronchial tree of blood, gastric contents, followed by the use of the necessary traumatic measures to remove them;
- a reduced state of immune defense;
- the presence of heart failure;
- pathology of the endocrine system and hypovitaminosis;
- thromboembolic complications during surgery;
- intense dehydration, hypokalemia .
Additional reasons that increase your risk of developing pneumonia include:
- elderly age;
- large volume and duration (2 hours or more) of the operation;
- the use of therapy that can suppress immunity – cytostatics , glucocorticosteroids or radiation therapy.
Persons who are also shown mechanical ventilation in the postoperative period need constant monitoring of the possible development of pneumonia. This also applies to patients who are in serious condition and have undergone tracheostomy – the formation of an anastomosis of the tracheal cavity with the environment.
After interviewing the patient, the doctor proceeds to the examination using a stethophonendoscope , which, in the presence of postoperative pneumonia, can provide comprehensive information. The presence of wheezing, signs of lung tissue compaction – all this indicates the need to connect additional examination methods, both instrumental and laboratory.
When diagnosing pneumonia as a complication after surgery, the following measures are taken:
- First of all, a survey radiography of the chest cavity organs is prescribed. It can help not only in making a diagnosis, but also in tracking the mechanism of the development of pathology in this particular case.
- To assess the patient’s condition, blood is taken for a clinical analysis. It provides information about the general state of the body: the degree of intoxication, inflammatory response and immune response. Important indicators are the level of leukocytes, leukocyte formula and erythrocyte sedimentation rate.
- To obtain additional data, a biochemical blood test may be prescribed to determine an increase in the level of inflammatory markers: C-reactive protein and fibrinogen. But these indicators are nonspecific. Both the first and the second, can increase with any inflammatory process, for example, with appendicitis or pyelonephritis.
- Further, to determine the most effective therapy for pneumonia, it is important to establish a specific type of pathogen – a microorganism that provokes inflammation. For this, bacteriological examination of sputum is used as the main method. In some cases, bronchoscopy is performed with the isolation of material samples directly from the lower respiratory tract.
- In a serious condition or an unclear picture, a technique such as ultrasound examination of the pleural cavities may be prescribed.
Timely, competent and individual selection of the treatment regimen is the key to victory over such complications as pneumonia after surgery. The basis of tactics is etiological therapy aimed at combating the causative agent of the disease in a particular case. Given that bacteria are the most common cause of postoperative pneumonia, antibiotics are the key drugs. When selecting a specific remedy, the severity of the patient’s condition, the possible presence of intolerance to a particular drug, is also taken into account.
Typically, multiple antibiotics are selected. The most commonly prescribed are the following:
- macrolides – Azithromycin, Clarithromycin , Erythromycin;
- fluoroquinolones II-III generation – Ofloxacin , Levofloxacin ;
- cephalosporins – Ceftriaxone , Cefazolin, Cephalexin .
In the case of a serious condition of the patient, a potent combination therapy ( carbapenems + cephalosporins) is indicated . With staphylococcal pneumonia, it is rational to prescribe penicillins to the patient, including protected ones (Amoxicillin + Clavulanic acid).
In the complex therapy of this postoperative complication, the following are also used:
- mucolytics – they normalize breathing and have an expectorant effect;
- antipyretic – in case of a persistent increase in body temperature;
- intravenous administration of glucose, physiological and saline solutions – if the patient is unable to take the necessary liquid and nutrients on his own.
A comprehensive approach allows you to achieve a favorable outcome of the disease and prevent the development of negative consequences.
Physiotherapy and folk remedies
In addition to drugs, physical therapy is an important component of pneumonia treatment. It is carried out after the acute inflammatory process subsides and may include various techniques: UHF, electrophoresis, ultraviolet irradiation, various applications, mustard plasters.
In the treatment of postoperative complications, the use of traditional medicine methods is permissible. Decoctions of wild rose and linden, infusions of aloe and birch buds are effective. Inhalations based on horseradish, plantain, honey may be helpful. However, when using these techniques, especially if the child is sick, it is important to consult with your doctor.
Preventive measures and prognosis
Full compliance with the instructions of a specialist is an important point in the prevention of postoperative pneumonia. Among them, the main ones are the following recommendations:
- compliance with the prescribed regimen, in the case of serious interventions on the heart, organs of the chest and abdominal cavity, the brain – this is complete rest;
- if necessary, regular aspiration of fluid from the respiratory tract;
- constant change in the patient’s posture in bed (as far as possible) to prevent congestion;
- strict adherence to the prescribed diet;
- introduction to the therapeutic gymnastics regimen;
- step-by-step restoration of the patient’s activity.
A prophylactic exercise that prevents the development of complications in the lungs after surgery is such a simple exercise as inflation of a balloon. In addition to regime measures, specialized therapeutic measures are also used:
- vitamin therapy;
- the appointment of digitalis powder to elderly people in order to improve blood circulation;
- the introduction of a solution of glucose with vitamin C intravenously.
Among the products that help to strengthen the weakened body, the key ones are milk, dried fruit compotes and vegetable purees, low-fat meats and fish. They have a beneficial effect on the activity of the esophagus, stomach and intestines, supply the body with nutrients. Drinking plenty of fluids and adhering to a diet are important in the fight against the development of complications. In the case of a severe postoperative condition of the patient, dietary recommendations are determined separately.
This complication does not go away by itself. The prognosis for recovery after surgery and the cure of pneumonia is favorable only with timely initiation of therapy.