An acute abscess is differentiated from diseases that can cause cavities in the lungs: tuberculosis, lung cancer, lung cysts, bronhaektaziey, fungal infection, acute destructive pneumonia (caused by Gram-negative bacteria and Staphylococcus aureus), septic embolism, and pulmonary embolism complicated by pulmonary infarction.
Treatment of acute lung abscess
The mainstay of treatment of most patients with acute pulmonary suppuration are intensive conservative therapy complex using a number of minor surgery techniques and endoscopic techniques.
Complex conservative therapy include:
maintain and restore the general condition and the correction of homeostasis;
inhibition of microorganisms - causative agents of infectious process (including viruses);
ensure optimal drainage of foci of destruction in the lung (pleura in);
correction of immunological reactivity.
In the presence of foul-smelling sputum or fetid breath the patient must be isolated from other patients.
The diet should be diverse, high-calorie, vitamin and contain a large amount of protein. Protein losses replenished by infusion of protein hydrolysates - aminokrovina (clarified) gidrolizina (clarified) infuzamina, as well as solutions of amino acids - polyamine amikina etc. The energy balance is supported by the introduction of concentrated solutions of glucose with the addition of appropriate amounts of insulin (1 IU to 3-4 g glucose).
In severe anemia produced transfusion of fresh blood or packed red blood cells.
In the most severe patients used hemosorbtion or plasmapheresis, extracorporeal ultraviolet blood irradiation.
In order to combat hypoxemia with oxygen therapy shows nasal catheter, hyperbaric oxygenation.
Antibiotic therapy is conducted after the bacteriological examination of bronchial contents with the identification of pathogens and their sensitivity to antibiotics. We recommend broad-spectrum antibiotics: semi, aminoglycosides, tetracyclines, quinolones.
The development and outcome of pulmonary suppuration is largely dependent on the state of the bronchi draining the abscess, their ventilation and drainage function.
The natural separation of the decay products of lung tissue through the draining bronchus can be enhanced by intravenous administration of appropriate antibiotics (p.2), steam inhalation 2% solution of sodium bicarbonate, postural drainage.
For the active evacuation of phlegm from the bronchial drainage performed bronchoscopic sanitation, complemented with the introduction of mikrotraheostomiey flexible catheter into the bronchus of the affected lung.
With significant amounts of cortical localization of the abscess and abscess are effective transthoracic puncture to aspiration of purulent masses, followed by the introduction of an antibiotic directly into the cavity of the abscess.
At the height of the infectious process is widely used means of substitution (passive) immunotherapy. These include svezhetsitratnoy infusion of blood and plasma containing antibodies, as well as some factors of nonspecific protection. Seriously ill patients are shown intravenous infusions of human gamma globulin. Have a positive effect of immunomodulatory medications: nukleinat sodium, levamisole, diutsifon, pentoksil and methyluracil, T-activin and timalin.
When failure of conservative measures is surgical intervention. The indications for it are the complications of acute lung abscess: profuse bleeding or progressive hemoptysis, pneumoempyema, empyema, suspected tumor or gangrene if an abscess diameter of more than 6 cm
If not carried through the treatment of acute abscess, the latter may pass into the chronic form. In order to detect and stop this process, you need a radiological control after 3 months of recovery.
