Pneumonia after surgery

Synonyms

Postoperative pneumonia, postoperative pneumonia, postoperative pneumonia, postoperative pneumonia, postoperative pneumonia

definition

At a lung infection it is generally acute or chronic inflammatory processes in the area of ​​the lung tissue. If pneumonia occurs immediately after an operation, it is called one postoperative pneumonia (Technical term: pneumonia).

introduction

An operation always carries a multitude of possible risks. Although complications do not arise after every surgical procedure, doctors must provide information about possible risks at least 24 hours before a planned surgical procedure. In addition to impairment of the cardiovascular system, wound healing disorders and blood loss, pneumonia is one of the most feared complications that can occur after an operation. In general, inflammatory processes in the lung tissue can be caused by bacterial as well as viral pathogens or fungi. Since this is a so-called stationary (synonym: nosocomial) pneumonia, a special pathogen often plays a decisive role. Nosocomial pneumonia, which also includes pneumonia after surgery, is always referred to when the inflammatory processes appear no later than two to fourteen days after the hospital stay.

In addition, pneumonia is divided into two classes after an operation:

• If an actually healthy patient falls ill with pneumonia after an appendix operation, for example, without showing a particular risk for this disease, one speaks of a primary pneumonia.
• The secondary pneumonia on the other hand, it is found in people who belong to a special risk group. In this context, people with limited immune systems, smokers, patients receiving radiation therapy and asthmatics are at particularly high risk.

In addition, pneumonia can be divided into two more classes:

• Typical pneumonia: A so-called Typeisch Pneumonia is caused by bacterial pathogens such as pneumococci or staphylococci.
• Atypical pneumonia: In the atypical Pneumonia is mostly based on a viral pathogen. Infection with fungi or obligate intracellular bacteria cannot be excluded in atypical pneumonia.

Symptoms

At a typical Pneumonia after surgery, symptoms typically appear suddenly. The affected patients often develop a fever a short time (a few days) after the operation. In addition, the inflammatory processes in the lung tissue can lead to impairment of respiratory function. As a result, the affected patients experience classic symptoms such as rapid, shallow breathing and shortness of breath. Pneumonia after surgery often leads to general symptoms such as exhaustion, tiredness, breath-dependent pain and productive cough.

A atypical Pneumonia after surgery, on the other hand, typically manifests itself as a gradual onset of symptoms. With this form of pneumonia, too, those affected develop a productive cough, which, however, is comparatively clear and weak. In addition, atypical pneumonia has a lower increase in fever and headache and limb pain. The possible shortness of breath that may occur is usually less pronounced with this form of pneumonia.

You can find more information on this topic on our website:

• How do I recognize pneumonia?
• Pneumonia pain

causes

The likelihood of pneumonia occurring in connection with a surgical procedure depends on both the type of surgery and the type of sedation performed.

Pneumonia can often be observed in patients who are already immunocompromised, especially after heart operations. Although pneumonia after an operation is also caused by bacterial or viral pathogens, insufficient ventilation in postoperative pain-related, insufficient breathing activity is the main cause. In addition, the occurrence of postoperative pneumonia can often be observed in long-term ventilated patients.
In the case of pneumonia acquired on an outpatient basis (i.e. outside of the hospital), streptococci (Streptococcus pneumoniae), Haemophilus influenza, Chlamydia pneumoniae or Legionella a crucial role.
On the other hand, enterobacteria, E.coli, Proteus, Serratia, Klebsiella (Klebsiella pneumoniae) and Pseudomonas aerguinosa can be detected in people who develop pneumonia after surgery.

It can also occur as part of a hospital infection.

Read more about the topic here: Hospital germs or Causes of Pneumonia

Complications

Since that immune system is already weakened after a long operation, postoperative pneumonia can quickly lead to complications. The so-called respiratory failure is one of the most feared complications in this context. Since the affected patients can only breathe inadequately due to the inflammatory processes within the lung tissue, the oxygen supply to all organs can be affected. For this reason, respiratory failure is one of the main complications of pneumonia after an operation. In the course of the disease, those affected experience an enormous drop in oxygen saturation with a simultaneous increase in the carbon dioxide (CO2) concentration in the blood (global insufficiency). Symptoms of the affected patients are pronounced shortness of breath, a superficial one Panting, Cyanosis (Blue discoloration of the lips and skin), confusion, restlessness and fear.

diagnosis

As soon as a patient has pneumonia after surgery, an exploratory examination of the chest is carried out. When listening to the lungs, rattling breath noises, which indicate an inflammatory infiltrate, are usually noticed. These breathing sounds are primarily caused by compression of the lung tissue and mucus deposits in the airways. In addition, an overview of the chest should be taken. If there is pneumonia that has occurred after an operation, so-called shadows (areas that are significantly lighter than the surrounding lung tissue) can be seen on the X-ray.

Since a laboratory examination of the coughed up secretion is usually too imprecise to identify the causative agent, a so-called bronchoscopy should be performed in pronounced cases. In this examination method, a flexible tube is pushed through the mouth into the airways. In this way, samples can be taken directly from the bronchi. A blood test is also essential if pneumonia is suspected to occur after an operation. Due to the inflammatory processes, bacterial pneumonia shows an increase in the number of white blood cells (leukocytes) in the blood. In addition, the so-called C-reactive protein (CRP) is significantly increased in a patient with pneumonia. Viral pneumonia, on the other hand, typically only causes a slight increase in white blood cells.

Find out all about the topic here: Diagnosis of pneumonia.

therapy

The treatment of pneumonia that occurs after an operation depends on both the extent of the inflammatory processes and the general condition of the patient concerned. First of all, the person concerned is supplied with oxygen through so-called oxygen glasses. This is intended to improve the oxygen saturation of the red blood cells. In the case of pronounced pneumonia that occurs after an operation, the administration of pure oxygen may not be sufficient. In these cases, mechanical ventilation must be considered.

Close control of blood gases and constant monitoring of oxygen saturation are essential during pneumonia treatment. In the case of pneumonia caused by bacterial pathogens that occurs after an operation, antibiotic treatment must be initiated. In addition, the fever associated with the inflammatory processes should be treated with antipyretic measures. The use of calf compresses and the administration of antipyretic medication, such as paracetamol or acetylsalicylic acid (ASA), are particularly suitable for effective fever reduction. In addition, the affected patient must ensure that they drink at least 1.5 liters of fluids per day.

The healing process can also be positively influenced by early mobilization of the person affected and special breathing therapy. The administration of cough suppressants (so-called antitussives) such as codeine, however, is now controversial. In the case of particularly severe pneumonia that occurs after an operation, the affected patient may need intensive medical surveillance. Post-op pneumonia caused by viral pathogens or fungi is usually much more difficult to treat. In these cases, the focus is on specific treatment with antimycotics (anti-fungal drugs) or antiviral drugs (anti-virus drugs).

For more information, read on here: The therapy of pneumonia.

Prognosis / chances of survival

The prognosis or chances of survival of pneumonia that occurs after an operation depend primarily on the extent of the inflammatory processes and the general condition of the patient concerned. A less pronounced pneumonia after an operation has a good prognosis if appropriate therapy is initiated quickly. With proper treatment, the inflammatory processes usually heal completely within two to three weeks. Processes of up to twelve weeks can only be observed in individual cases.

Since atypical pneumonia in most cases has a milder course, the prognosis or chance of survival of viral pneumonia after an operation is also considered to be significantly better. This form of pneumonia usually heals completely within two weeks in uncompromised patients. Only with old and / or immunocompromised Patients have a significantly poorer chance of survival from pneumonia that occurs after an operation. On average, it is assumed that the Mortality rate (Fatality rate of the disease) with ordinary pneumonia is only 0.5 percent, but the previous operation has a negative effect on the already weakened immune situation of those affected.

Risk of contagion

Pneumonia is an infectious disease caused by bacterial or viral pathogens (more rarely fungi). Regardless of whether it is classic pneumonia or pneumonia after surgery, this disease is contagious. The causative pathogens are usually through Droplet infection transfer. Pneumonia is therefore contagious if you come into contact with the infected secretion.

Read everything about this topic under: How contagious is pneumonia?

How dangerous is pneumonia after an operation?

Pneumonia is a dangerous disease that definitely requires treatment, as it can be potentially fatal. Consistent treatment is necessary, especially after an operation, because the pneumonia then falls during a period in which the patient especially weakened is and the disease often only moderate power reserves and a reduced immune system are opposite.

How dangerous pneumonia after surgery is depends on several factors. First and foremost, it is about the general health of the patient. If the patient is young, healthy and strong before the operation, it can be assumed that the pneumonia will develop positively under the correct treatment.

If the patient is elderly and has multiple previous illnesses, there is a risk that the therapy will be lengthy and difficult.

The patient's health is also critically important to the likelihood that pneumonia will develop in the first place. Young patients who recover quickly after surgery, do physiotherapy and can leave the hospital soon, do not get pneumonia as quickly as older and seriously ill patients who recover more slowly.

Patients with immunodeficiency diseases or an immune system that has been compromised by chemotherapy are also particularly at risk from pneumonia. Another factor that is also reflected in the danger of pneumonia is the type of operation. A less complicated operation on the extremities is to be expected than with an operation on the heart, lungs or abdominal organs. Even with long ventilation that is necessary after the operation, a complicated course of the pneumonia is more likely.

The same applies to long stays in intensive care units. In the hospital environment, there are also more germs that are resistant to various antibiotics. Since antibiotics are essential in the treatment of pneumonia, a quick response of the pathogen to the therapy is beneficial. However, if the pneumonia can be traced back to antibiotic-resistant germs, there is a risk of a long and complicated course.

Find out more about the topic here: Antibiotics for pneumonia.

Duration of pneumonia after surgery

It is extremely difficult to make statements about the duration of pneumonia after surgery. If the course is uncomplicated, if the body responds quickly to the antibiotics administered and if the patient's immune system is intact, a duration of two to three weeks can be assumed. As shown in the previous section, however, a variety of factors have an influence on the course of the disease.

A significantly longer course is possible in patients who suffer from pre-existing lung diseases. These include primarily the Chronic bronchitis and the COPD. In both diseases there is a permanent inflammation of the lower respiratory tract, which in one increased mucus production and one reduced self-cleaning function the bronchi results. The body only has the limited ability to independently fight the bacteria responsible for pneumonia. The duration of pneumonia after surgery is often considerably longer. If patients are artificially ventilated for a long time after an operation, this increases both the likelihood and duration of pneumonia. With long-term ventilation, the weakened respiratory muscles are no longer able to move mucus out of the bronchi with a strong cough. Self-cleaning is also impaired by the ventilation tubes used. In addition, the risk of contracting antibiotic-resistant hospital germs increases. In intensive care units, especially with ventilated patients, pneumonia can therefore be observed to be particularly long after surgery.

Pneumonia after heart surgery / bypass surgery

As already illustrated, the patient's condition plays a crucial role in coping with pneumonia after surgery. Heart surgeries are often major interventions that involve a long ventilation, possibly one too Post-ventilation is required in the intensive care unit. In addition, the patient clientele is often people with multiple previous illnesses with a long history of illness. The prevention and treatment of pneumonia must therefore be carried out with great care by doctors and nursing staff. Through the use of antibiotics, which can also be done preventively and through adequate physical therapy, pneumonia after heart surgery can often be avoided or treated well.

One of the most frequently performed heart operations worldwide is the so-called Bypass surgery. Here will be bypassed calcified sections of the coronary arteriesby creating bypasses through the Introducing the body's own veins or arteries, be created. The operation must be performed with the opening of the chest on the open heart. So that the surgeon can work well, a Cardiac arrest necessary. The heart is replaced by a heart-lung machine for the duration of the operation. Although bypass surgery is carried out daily and routinely in Germany today, the patient must be able to recover sufficiently from this major procedure afterwards. Pneumonia, as with other heart operations, is a dangerous complication that must be treated immediately and intensively

Pneumonia after lung surgery

In the case of operations on the lungs, it must often be assumed that the patient suffers from previous illnesses. Often these affect the lungs directly. Patients who have to undergo operations in specialist pulmonary clinics are often smokers, suffer from chronic bronchitis or COPD. Due to the close functional relationships between the heart and the lungs, accompanying heart diseases often exist. The treatment of pneumonia after surgery is often made more difficult. The surgical techniques themselves are also dangerous. Persistent pain in the operated half of the chest often weakens the cleansing cough. The operation itself and the ventilation techniques used also impair the self-cleaning mechanisms of the lungs even after the operation has ended. In a lung specialist center, you are therefore prepared for the complicated course of pneumonia and can usually react well.