Determine the morbidity risk level in time

Pneumonia is a respiratory infection that primarily affects the small air sacs (alveoli) and interstitial tissue of the lungs. No infection claims more lives in industrialised nations than pneumonia. According to WHO, pneumonia is the leading infectious cause of death in children under five years old worldwide.([FOOTNOTE=Walker CL et al. Global burden of childhood pneumonia and diarrhoea. The Lancet. 2013; 381(9875), 1405–1416.],[ANCHOR=],[LINK=])

The most common symptoms of pneumonia are:

  • Cough
  • Difficulty breathing
  • Rapid heartbeat
  • Fever
  • Sweating and shivering
  • Loss of appetite
  • Chest pain

The diagnosis of pneumonia is complicated, as its symptoms can be both typical and atypical, and as such, can often seem to conflict with one another. Typical pneumonia can present very suddently, often with fever and a productive cough. On auscultation, crackling sounds may be audible. Atypical pneumonia, on the other hand, presents with the gradual onset of an unproductive cough, shortness of breath, and a variety of non-lung symptoms. Auscultation may not indicate any issue. In reality, some patients may present both typical and atypical symptoms. There is a broad spectrum of pathogens associated with both typical and atypical pneumonia.

Classification of pneumonia2

Classification of pneumonia2
Type of pneumonia Common pathogens
Community-acquired pneumonia Typical pneumonia Typical pneumonia

Streptococcus pneumoniae (most common) - Most common also in nursing home patients

Haemophilus influenzae

Atypical pneumonia

Mycoplasma pneumoniae (most common in the ambulatory setting)

Chlamydophila pneumoniae

Legionella pneumophila - legionellosis

Coxiella burnetti

Hospital-acquired pneumonia  

Gram-negative pathogens

1. Pseudomonas aeruginosa

2. Enterobacteriaceae

Staphylococci (Staphylococcus aureus)

Streptococcus pneumoniae

Special Groups
Pneumonia in immunocopromised patients

Encapsulated bacteria

Pneumocystis jirovecii (Pneumocystis jirovecii pneumonia)

Aspergillus fumigatus (Aspergillosis)

Candida species (Candidiasis)

Cytomegalovirus

Pneumonia in newborn infants

Eschericia Coli

Group B streptococcus (Streptococcus agalactiae)

Streptococcus pneumoniae

Haemophilus influenzae

Recurrent pneumonia Unusual organisms (e.g., Nocardia, Coxiella burnetii, Aspergillus, Pseudomonas aeruginosa)

Prevalence Of pneumonia

Both community-acquired and hospital-acquired pneumonia are major causes of death in the developed world.([FOOTNOTE=Steel H, Cockeran R, Anderson R, et al. Overview of community-acquired pneumonia and the role of inflammatory mechanisms in the immunopathogenesis of severe pneumococcal disease. Mediators Inflamm. 2013: 490346.],[ANCHOR=],[LINK=]),([FOOTNOTE=Montravers P, Harpan A, Guivarch E, et al. Current and future considerations for the treatment of hospital-acquired pneumonia. 2016. Adv Ther;33(2):151-66.],[ANCHOR=],[LINK=])

According to a report by the National Institute for Health and Care Excellence (NICE) every year, a total of 0.5%-1% of adults in the UK will be diagnosed with community-acquired pneumonia.([FOOTNOTE=National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. 2014.],[ANCHOR=],[LINK=]) In addition, community-acquired pneumonia is diagnosed in 5–12% of adults who present to GPs with symptoms of lower respiratory tract infection, and subsequently, 22–42% of these individuals are admitted to hospital, with the mortality rate of 5-14%.5 Moreover, between 1.2% and 10% of adults admitted to hospital with community-acquired pneumonia are managed in an intensive care unit, with the risk of mortality greater than 30%.5 More than half of pneumonia-related deaths occur in people older than 84 years.5

Further, NICE reports that around 1.5% of hospital inpatients in England will have a hospital-acquired respiratory infection at any given time, where hospital-acquired pneumonia (HAP) will account for more than half of these infections.5 It has been demonstrated that hospital-acquired pneumonia can increase the average hospital stay by around 8 days, with reported mortality of from 30-70%.5

RISK FACTORS OF PNEUMONIA([FOOTNOTE=Mayo Clinic. Pneumonia. Accessed at:https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204],[ANCHOR=],[LINK=])

  • Weakened immune system (for instance people who have HIV/AIDS, who are alcoholic, who have undergone chemotherapy)
  • Being hospitalized or being on a ventilator
  • Having a chronic condition including asthma, chronic obstructive pulmonary disease, structural lung disease and heart disease
  • Smoking

 

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Difference between hospital-acquired pneumonia and ventilator- associated pneumonia

HAP is classified as a [respiratory tract infection] which develops 48 hours after hospital admission, and which did not appear to be developing at the time of admission. Ventilator-associated pneumonia (VAP) is a common subtype of HAP that occurs 48–72 hours after endotracheal intubation.([FOOTNOTE=American Thoracic Society. Guidelines for the management of adults with hostpital-acquired, ventilator-associated and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171 (388–416).],[ANCHOR=],[LINK=]) 

Diagnosis will primarily rely on pathogen detection in blood, urine and sputum samples.5 Typical pneumonia chest X-rays will show extensive opacity localised to just one of the lung lobes, while atypical pneumonia presents with more subtle, non-lobar interstitial infiltrates.2 

Treatment of pneumonia

Almost all the major decisions regarding management of pneumonia, including diagnostic and treatment issues, revolve around determining whether patients are at low, intermediate or high risk of death. This is done by using the CURB-65 score.([FOOTNOTE=Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58: 377–82],[ANCHOR=],[LINK=]) While patients presenting with low-severity community-acquired pneumonia won’t usually be required to take microbiological tests, patients with moderate- or high-severity community-acquired pneumonia will. Blood and sputum cultures should be obtained, and in some cases pneumococcal and legionella urinary antigen tests may be required.5

The results of these tests will guide antibiotics therapy, be it single or combined. Admission to hospital or ICU is recommended for severe cases. The following treatments may be employed to decrease ICU patient morbidity([FOOTNOTE=Leone M, Bouadma L, Bouhemad B, et al. Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain. 2018;37(1):83-98],[ANCHOR=],[LINK=]):

▪ Noninvasive ventilation to avoid tracheal intubation (which can lead to VAP)

▪ If tracheal intubation is required, orotracheal will generally be preferred over nasotracheal, and tube cuff pressure will be carefully monitored

▪ Sedatives and analgesics will be utilised only when necessary and in limited doses

▪ Provide nutrition via enteral feeding (feeding tube)

▪ Perform sub-glottic suction every 6 to 8 hours to avoid oral secretions being inhaled by the patient

Discover below the respiratory and monitoring products from Medtronic that can help the treatment of patients who have been diagnosed with pneumonia.

Recommended Products

Puritan Bennett™ 980 acute care ventilator - Engineered to Help Patients Breathe More Naturally
McGRATH™ MAC video laryngoscope - Respond to both routine and difficult airways
Shiley™ Evac endotracheal tube wth TaperGuard™ cuff - A simple way to remove subglottic secretion

Puritan Bennett™ 980 acute care ventilator

Engineered to Help Patients Breathe More Naturally

McGRATH™ MAC video laryngoscope

Respond to both routine and difficult airways

Shiley™ Evac endotracheal tube wth TaperGuard™ cuff

A simple way to remove subglottic secretion

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