Pneumonia is an inflammatory lung disease that occurs under the influence of various pathogens. Severe pneumonia develops when inflammation of the lungs causes bacterial, viral, and mycotic associations of microorganisms. Treatment of severe pneumonia in adults requires special approaches. Patients with severe pneumonia are hospitalized in the intensive care unit of the hospital.
Oxygen is centrally supplied to the wards. Resuscitation doctors constantly monitor the functioning of the respiratory and cardiovascular systems with the help of cardiac monitors, and determine the level of oxygen in the blood. All patients receive oxygen therapy. Patients with severe respiratory failure perform artificial ventilation of the lungs using stationary and portable devices.
Criteria for the severity of pneumonia
An objective assessment of the severity of the patient’s condition is necessary to make a decision on the tactics of patient management, transportation, and the optimal place for complex therapy. There are 3 degrees of severity of the course of pneumonia. A mild course is characterized by unexpressed symptoms of intoxication, an increase in body temperature to low numbers, the absence of respiratory failure, hemodynamic disturbances and concomitant pathology. On radiographs, pulmonary infiltration is determined within one segment, in the general blood test, an increase in the number of leukocytes is noted to 9.0-10.0 × 109 / l.
For an average severity of the course of pneumonia, the following symptoms are characteristic:
- An increase in body temperature up to 38 ° C;
- Moderate symptoms of intoxication;
- The presence of a pulmonary infiltrate within 1-2 segments;
- Respiratory rate up to 22 per minute;
- Increase in heart rate up to 100 beats per minute;
Severe pneumonia is manifested by pronounced symptoms of intoxication, a severe general condition of the patient. The body temperature rises to 38.0 ° C, there are signs of respiratory failure of the II-III degree. Hemodynamic disorders are noted: blood pressure is below 90/60 mm Hg. heart rate more than 100 beats / min. Patients develop septic shock and the need for vasopressors arises.
In the clinical analysis of blood, a decrease in the number of leukocytes (white blood cells) less than 4.0 × 109 / l or leukocytosis of 20.0 × 109 / l with the number of immature neutrophils more than 10% is determined. Radiographs show multilobe bilateral pneumonic infiltration. The pathological process progresses rapidly , the infiltration zone increases by 50% in 48 hours of observation.
The following complications of pneumonia develop: abscesses, exudative pleurisy, disseminated intravascular coagulation syndrome, sepsis, failure of other organs and systems. In patients, consciousness is impaired, and related diseases are exacerbated.
Causes of Severe Pneumonia
Most severe pneumonia is caused by pneumococcus and Haemophilus influenzae. Severe pneumonia develops when the respiratory tract is infected with Legionella, Staphylococcus aureus, Gram-negative bacteria, Klebsiella. In winter, severe viral pneumonia prevails. Quite often, pneumonia caused by mycoplasmas and chlamydia is severe. Antibiotic-resistant bacterial strains are of particular importance in the origin of severe pneumonia.
Risk factors for the development of antibiotic resistance of pneumococci are:
- The age of patients is less than 7 years old and more than 60 years old;
- Previous exposure to antibiotics,
- The presence of related diseases;
- HIV infection.
- Pseudomonas aeruginosa is more resistant to antibiotics.
Severe pneumonia treatment
Treatment of severe pneumonia is carried out in a hospital setting with hospitalization of the patient in the intensive care unit.
First of all, emergency therapy is performed, aimed at eliminating syndromes that pose a threat to the patient’s life.
If a severe form of pneumonia is diagnosed, resuscitation is carried out with complications such as:
- In acute respiratory failure, tracheal intubation is indicated in severe pneumonia, transfer of the patient to artificial ventilation of the lungs, aspiration sanitation of the trachea and bronchi.
- In case of infectious toxic shock due to the diagnosis of severe pneumonia, resuscitation includes infusion therapy.
- With broncho-obstructive syndrome, when it becomes impossible or difficult to breathe with pneumonia, oxygen therapy is performed, aimed at continuous oxygen supply.
Intensive therapy for severe pneumonia is carried out by:
- Antibiotic therapy;
- Taking anticoagulants;
Treatment for severe pneumonia in adults includes:
- Antibiotic therapy;
- Infusion therapy;
- Oxygen therapy;
- Artificial ventilation of the lungs (according to indications);
- Taking analgesics.
Further recommendations for severe pneumonia and its treatment are carried out in accordance with the course of the disease.
If treatment is successful, follow-up vaccination with pneumococcal and influenza vaccines is recommended to avoid repeated episodes of pneumonia.
After the transferred disease, a long period of rehabilitation is required, since it becomes difficult to breathe after pneumonia, this is due to damage to the lungs and a partial violation of their function.
The lungs should be strengthened with a special respiratory
Severe pneumonia prognosis
Judging by the reviews of people who have suffered pneumonia and relatives of those patients who have had severe pneumonia, the prognosis directly depends on the patient’s age and the state of his immunity.
Most often, severe bilateral pneumonia ends in death in persons of retirement age with a history of endocrine and other chronic diseases.