The Role of Cardiovascular Disorders in the Pathogenesis of Acute Pneumonia-Juniper Publishers
JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF CARDIOLOGY & CARDIOVASCULAR THERAPY
Pneumonia is a leading cause of hospitalization among
children in the United States, with medical costs estimated at almost
$1 billion in 2009. Despite this large burden of disease, critical gaps
remain in our knowledge about pneumonia in children [1]. “The rates of
para pneumonic effusions have been increasing in the USA and Europe over
recent years, and it is now encountered in approximately 40% of all
patients with bacterial pneumonias” [2]. “Pediatric pleural empyema has
increased substantially over the past 20 years and reasons for this rise
remain not fully explained” [3]. The above quotes indicate low
efficiency of the modern treatment of acute pneumonia (AP) and the
absence of an explanation for this fact. Such a situation implies the
search for new solutions to the problem.
To the present time, obtained much evidence of the
important role of lung reflexes in the development and course of (AP).
However, studies in this direction are mostly experimental and their
clinical application is not even discussed [4,5]. I would like to offer
the results of my research, which was published originally in Russian
[6], and that may be interesting and informative for experts dealing
with the problem of AP.
The research was conducted in the clinic of pediatric
surgery (Novokuznetsk, Russia) in 1982-1985 in patients with severe AP
in the initial period of the disease. At that time children with the
most aggressive forms of AP were selectively admitted to our department.
These patients were non-surgical profile. The reason for the
hospitalization was the fact that the surgical clinic was the only place
in our area for intensive care. This group of patients differed high
mortality and fast development of pleural complications. Unsatisfactory
results of conventional treatment (massive doses of antibiotics, oxygen
supply, intravenous infusion) forced us to find ways to solve the
problem.
The following procedures have been used as a means of first aid in patients on admission.
- Сervical vago sympathetic blockade (CVB) performed with 0.25% solution of novocaine on the side of inflammation. This type of blockade was allowed for clinical use and widespread in the Soviet Union, where the work was performed. These blockades were mainly recommended for carrying out differential diagnosis between abdominal syndrome of AP and acute appendicitis in children.
- Cups therapy (Cup T) performed at the rate of 1 cup (50 cubic centimeters) to 4kg body weight.
- Cold wet wraps the body within a few minutes. This procedure is usually performed in patients with hyperthermia to the normalization of the temperature.
The effectiveness of procedures was evaluated by
using comparative rheopulmonography (RPG). Record indicators was carried
out prior to and immediately after the procedure. The electrodes for
recording were applied on the side of the chest wall at the level of 3-4
ribs. Electrodes remained in the same place for the implementation of
re-recording. Recording was carried out on the RPG-4 unit, “Elkar”
(USSR). The age of patients these studies ranged from 3.5 to 14 years.
Comparative RPG parameters were recorded in 22 children after CVB and in
14 children after the CupT. The effectiveness of cold wraps according
to clinical signs was the most demonstrative, but we were not able to
record the objective results.
Comparative RPG allowed to evaluate the respiratory
rate (RR), respiratory volume (RV), minute volume of ventilation (MV),
heart rate (HR), systolic wave amplitude (SA), minute pulsatory blood
flow (MBF), coefficient of ventilation-perfusion ratio (Kv/p). The
results were subjected to statistical processing.
Comparative RPG studies were objective evidence of the
effectiveness of CVB and Cup T. Thus, indicators of RR and
MV significantly decreased after the procedure, although RV
remained unchanged. Performance SA, MBF has changed
markedly, HR decreased to a lesser extent. In general, the
received data reliably indicated a decrease of hyperventilation
and improving perfusion. Baseline RPG indicated marked
predominance indicators ventilation over the blood stream.
Following treatment procedures, the ratio between these
parameters (Kv/p) align. This point was accompanied by a
significant improvement in the condition and well-being of
patients.
The obtained results allowed us to evaluate the mechanisms
of the development of the disease process in AP from new
positions. Suddenly emerging center of inflammation causes
reflectoric respiratory frequency excursions. Simultaneously
reflectoric spasm of lesser circulation impedes the blood flow
and causes delay and disruption of blood perfusion on the
periphery. Violation of metabolic processes is the next link after
the changes in the systemic circulation. Metabolism perversion
serves as an additional incentive to compensatory increase in
ventilation. Therefore, according to the original RPG, ventilation
rates prevailed over the blood flow rates (Kv/p more than 1).
The unique role of the lungs in the body is well known,
including non-respiratory functions. Also it is well known that the
reaction of everyone to certain stimulus has individual character.
Therefore, the speeds of development of inflammation, the
intensity of occurring disorders and the body’s ability to adapt
have a huge range of options. Reflex influence of inflammation
in the lung on the small circle of blood circulation causes the
inevitable restructuring of the systemic circulation.
The above-described changes in the peripheral circulation
correspond to the picture “shock”. Therefore homeostasis
violations at AP, we were treated as “pulmonary shock”.
Treatment methods to eliminate those violations were named
“anti-shock procedures”.
The characteristics and course of action of therapeutic
activities allow both inhibition of the inflammatory process
and its stimulation. Therefore it is very important to have an
understanding of the pathogenesis of the disease and the impact
of medical procedures on its links. And should recognize the
obvious fact that even more effective antibiotics will not allow to guarantee the prevention of the complications of AP. The key
solution to this problem is hidden in the pathogenesis of the
disease.
Performing SVB liquidates the reflectoric affect of
inflammatory focus on the pulmonary vessels. This effect allows
the body to eliminate violations of the central hemodynamics.
The results of comparative RPG after CVB and after the Cup T had
no significant difference. However, the mechanism of action of
the Cup T seems to be different. Cups application extracts part of
circulating blood and reduces venous return. This step unloads
the vessels of the small circle and probably removes them from
spasm. A similar mechanism will probably have cold wraps.
This procedure also facilitates partial blood sequestration and
pulmonary vascular unloading.
The presented above results have helped the author (along
with other studies) to review the AP pathogenesis. Described first
aid techniques entered in the obligatory treatment set of AP. The
combinations of innovations have achieved impressive results
of treatment of AP and declare the possibility of guaranteed
prevention of its purulent and destructive complications. These
results underline the fact that the AP is more circulatory than
respiratory disaster.
This study was done by applying primitive equipment, but
the results remain interesting today. Modern technology allows
to conduct a similar study on a more detailed level and to get
important information.
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