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pneumonia

Pneumonia

Pneumonia is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli.

Etiology

It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other conditions such as autoimmune diseases.

see Klebsiella pneumoniae

Streptococcus pneumoniae.

Classification

Risk factors

Risks of general anesthesia include: heart attack, stroke, pneumonia.


The routine use of sedatives and paralytics in neurotrauma patients may lead to a higher incidence of pneumonia, longer ICU stays, and possibly sepsis 1).


Early tracheostomy reduces the number of days of mechanical ventilation but does not affect mortality or incidence of pneumonia 2).


Patients with cervical SCIs are more prone to pneumonia due to the fact that most of the effort in a normal cough originates in the abdominal muscles which are paralyzed.


Whereas bringing gastric pH to a more neutral level reduces the risk of stress ulcer, pH > 4 permits bacterial colonization of the normally sterile stomach. This may increase the risk of pneumonia from aspiration, and there is a suggestion that mortality may also be increased.

Sucralfate may be as effective in reducing bleeding, but may be associated with lower rates of pneumonia and mortality. There is insuficient data to determine the net result of sucralfate compared to no treatment 3).

IV drip Ranitidine (provides a more consistently higher pH without peaks and troughs; some controversy that this may increase gastric bacterial concentration with increased risk of aspiration pneumonia has not been borne out): 6.25 mg/hr (e.g. inject 150 mg into 42 ml of IVF yielding 3.125 mg/ml, run at 2ml.

Clinical features

Typical signs and symptoms include a cough, chest pain, fever, and difficulty breathing.

Diagnostic tools include x-rays and culture of the sputum. Vaccines to prevent certain types of pneumonia are available. Treatment depends on the underlying cause. Pneumonia presumed to be bacterial is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized.

Pneumonia affects approximately 450 million people globally per year (7% of the population) and results in about 4 million deaths. Although pneumonia was regarded by William Osler in the 19th century as “the captain of the men of death,” the advent of antibiotic therapy and vaccines in the 20th century has seen improvements in survival.

Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death.

In the terminally ill and elderly, especially those with other conditions, pneumonia is often the immediate cause of death. In such cases, particularly when it cuts short the suffering associated with lingering illness, pneumonia has often been called “the old man's friend.”

Complications

References

1)
The Brain Trauma Foundation. The American Asso- ciation of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Initial manage- ment. JNeurotrauma. 2000; 17:463–469
2)
Brain Trauma Foundation, Povlishock JT, Bullock MR. Infection prophylaxis. J Neurotrauma. 2007; 24:S26–S31
3)
Cook DJ, Reeve BK, Guyatt GH, et al. Stress Ulcer Prophylaxis in Critically Ill Patients: Resolving Dis- cordant Meta-Analyses. JAMA. 1996; 275:308–314
pneumonia.txt · Last modified: 2019/07/11 23:08 by administrador