What Is Severe Pneumonia?

The severity of pneumonia depends on the degree of local inflammation, the spread of pulmonary inflammation, and the extent of systemic inflammatory reactions. For example, patients with pneumonia who have severe hypoxemia or acute respiratory failure need ventilation support, or have symptoms of circulatory failure such as hypotension and shock. Other organ dysfunction can be identified as severe pneumonia.

Basic Information

Visiting department

Respiratory Medicine

Common causes

Pneumonia infection with cardiopulmonary basis or additional risk factors, special pathogenic microorganism infection

Common symptoms

Respiratory failure, lethargy, lethargy, irritability, decreased blood pressure

Causes of severe pneumonia

Infection with pneumonia on the basis of cardiopulmonary or additional risk factors, or infection with special pathogenic microorganisms such as SARS virus, avian influenza virus, legionella, etc., will increase the severity of pneumonia and the risk of death. If the age is> 65 years, there are basic diseases or related factors, such as chronic obstructive pulmonary disease (COPD), diabetes, chronic heart and kidney dysfunction, chronic liver disease, history of hospitalization within 1 year, suspected aspiration, abnormal consciousness, spleen After resection, chronic alcoholism or malnutrition.

Clinical manifestations of severe pneumonia

1. Severe pneumonia will have the manifestation of respiratory failure. The main symptoms of the nervous system are depression, drowsiness, or irritability. In severe cases, there may be disturbance of consciousness, optic disc edema, coma, convulsions, and then cerebral hernia. Children with central respiratory failure And death.
2. Severe pneumonia can often lead to circulatory system involvement, manifested as weak pulse, increased heart rate, dull heart sounds, worsening cyanosis, and increased lung snoring. In the presence of shock and peripheral circulation failure, pale complexion, dull and moist skin, decreased urine output, decreased blood pressure, and prolonged capillary filling time will occur.

Severe pneumonia examination

1. Physical examination (1) Respiratory frequency 30 / min.
(2) Arterial systolic blood pressure <12.0 kPa (90 mmHg).
2. Blood test The total number of white blood cells can be increased or not increased in blood tests, but more than half of them can see nuclear shift to the left, increased C-reactive protein, and accelerated red blood cell sedimentation rate (erythrocyte sedimentation).
3. Arterial blood gas analysis When arterial blood oxygen partial pressure (PaO2) <8.0kPa (60 mmHg), oxygenation index (PaO2 / FiO2) <39.90 kPa (300 mmHg), mechanical ventilation treatment is required.
4. X-ray imaging showed bilateral or multiple lung lobes involved, showing atelectasis, often dissipating in one place and new infiltration elsewhere.

Diagnosis of severe pneumonia

Those who meet the following 1 major criteria or 3 minor criteria can be diagnosed as severe pneumonia.
1. Main criteria: tracheal intubation is required for mechanical ventilation; septic shock still requires vasoactive drugs after active fluid resuscitation.
2. Minor criteria: respiratory frequency 30 / min; oxygenation index 250 mmHg (1 mmHg = 0.133 kPa); multi-lobe infiltration; disorder of consciousness and / or orientation; blood urea nitrogen 7.14 mmol / L; systolic blood pressure <90mmHg requires active fluid resuscitation.

Severe pneumonia treatment

1. Drug treatment (1) Anti-infection treatment is the most important part of pneumonia treatment. Antibacterial treatment of bacterial pneumonia includes empirical treatment and anti-pathogen treatment. The former mainly selects antibiotics that cover possible pathogens based on the epidemiological data of pneumonia pathogens in the region and the unit; the latter chooses antibiotics that are sensitive to in vitro tests based on the culture of respiratory or lung tissue specimens and the results of drug sensitivity tests. In addition, antibiotics and routes of administration should be selected based on the patient's age, whether there are underlying diseases, whether there is a history of inhalation, whether to live in a general ward or intensive care unit, length of hospital stay, and severity of pneumonia. Severe pneumonia should attach importance to the diagnosis of pathogens, collect respiratory tract specimens early, and use various methods such as blood culture and serological detection to find pathogens.
(2) The treatment of severe pneumonia should first choose a broad-spectrum powerful antibacterial drug, and should be used in sufficient amount and in combination. Community-acquired pneumonia usually uses macrolides combined with third-generation cephalosporins, or broad-spectrum penicillin / -lactamase inhibitors, carbapenems; quinolones and aminoglycosides are used in patients with penicillin allergy. For hospital-acquired pneumonia, any of quinolones or aminoglycosides combined with -lactams, broad-spectrum penicillin / -lactamase inhibitors, and carbapenem antibiotics can be used against Pseudomonas. Can be combined with vancomycin. Most patients require 7 to 10 days or longer.
2. If necessary, transfer oxygen therapy to the hospital for mechanical ventilation.
3. Resolve phlegm to enhance sputum drainage. If necessary, inhale ambroxol and concentrated sputum.
4. Supportive therapy enhances immunity, as well as supportive therapy.

Prognosis of severe pneumonia

Active and rapid infection control can reduce complications.

Severe pneumonia care

1. Fever care When bed fever is high, you should rest in bed to reduce oxygen consumption. You can use physical cooling, or apply medicine to cool down as prescribed by your doctor. Intravenous supplementation of water and salt lost due to fever, monitor and record body temperature changes.
2. Chest pain care for those with obvious chest pain, assist in taking the affected side lying position, guide patients to press the affected side lying position with deep breathing and coughing, use local massage or distracting methods to relieve pain, and apply analgesics if necessary .
3. Cough and sputum care encourage patients to take a deep breath, assist in turning over and perform chest thumps, guide effective cough, and promote sputum excretion. When the sputum is thick and difficult to cough, patients can be encouraged to drink more water, and can also be given aerosolized inhalation.