Thursday, September 28, 2023

Getting Pneumonia In The Hospital

Hospitalized For Pneumonia: What To Expect And How To Ensure The Best Outcome

Naseeruddin Shah gets discharged from the hospital after getting treated for pneumonia

Every year more than 25,000 Americans get hospitalized for pneumonia. If you or your loved one has been hospitalized for pneumonia, you will find this article very useful. As a hospitalist, I have admitted and taken care of thousands of adult patients with pneumonia of different severities. I am sharing the most important aspects of pneumonia in hospitalized patients based on the latest scientific facts combined with my personal experience as a doctor. Namely, you will learn when you need to be hospitalized for pneumonia and what treatments to expect based on the severity of your pneumonia. You will also get important insights into what you can do to ensure you get the best treatment for your pneumonia. Finally, you will understand the two different aspects of treating hospitalized patients with pneumonia.

The current article mainly focuses on being hospitalized for pneumonia. Please read this other article if you would like to get an overview of different types of pneumonia and their symptoms.

How Is Hap Diagnosed

Your healthcare provider will listen to your lungs for abnormal sounds. You may also need any of the following:

  • Blood tests are used to check for infection.
  • An x-ray or CT scan may show infection, and how well your lungs are working. They may also show other problems, such as fluid around your lungs. You may be given contrast liquid to help your lungs show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.
  • A sputum sample may be tested for the germ that is causing your illness. It can help your healthcare provider choose the best medicine to treat the infection.

Differential Diagnoses Of Nosocomial Pneumonia

All patients with presumed nosocomial pneumonia should undergo testing to rule out conditions that mimic nosocomial pneumonia. The diagnosis of nosocomial pneumonia is difficult because it may present in a very nonspecific fashion.

Many conditions other than nosocomial pneumonia mimic pulmonary infiltrates on chest radiographs.

Clinical findings in ventilated patients with fever and/or leukocytosis may have alternative causes, including antibiotic-associated diarrhea, central lineassociated infection, sinusitis, urinary tract infection, pancreatitis, and drug fever. Noninfectious inflammation may produce fever.

The most common causes of infiltrates in ventilated patients with fever and/or leukocytosis include the following conditions:

  • Congestive heart failure

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Prognosis Of Patients Hospitalized For Pneumonia

Although the treatment of pneumonia has advanced significantly in the last 10 years, pneumonia is still a serious and potentially life-threatening disease. It is especially true in elderly patients with other pre-existing illnesses. On average, about 8% of patients hospitalized for pneumonia in the United States do not make it. On one study, the mortality rate of patients who were 65 years and older was even higher at 10%. As you have already learned, most patients with serious pneumonia are admitted to the ICU. It is, therefore, not surprising that almost 18% of them do not survive the illness.

Complications Caused By Pneumonia

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Pneumonia can sometimes have complications. They include:

  • pleurisy where the pleura, the thin linings between your lungs and ribcage, become inflamed, leading to chest pain. If you have pleurisy, you are more likely to develop fluid on the lungs.
  • fluid on the lungs – about 1 in 10 people with pneumonia develop fluid around the lung, called a pleural effusion which can become infected. This may require a sample of the fluid to be taken by inserting a needle between the ribs under local anaesthetic, and if infected is likely to need a longer course of antibiotics. Occasionally, a tube is inserted into the lung to remove fluid as well.
  • a lung abscess a rare complication thats mostly seen in people with a serious pre-existing illness or history of alcohol misuse.
  • blood poisoning, also called septicaemia – this is where infection spreads from the lungs to the blood stream. This can cause low blood pressure and a severe illness that might need intensive care treatment.
  • respiratory failure this is where pneumonia causes low levels of oxygen in the blood even in people given oxygen. This might also require intensive care treatment.

The vast majority of people recover from pneumonia and return to good health. However, pneumonia can be very serious and some people with severe pneumonia dont survive, despite the best available care. Those who are elderly or have other health problems are most at risk of severe or fatal pneumonia.

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Questions To Ask Your Doctor

  • I have a chronic condition. Am I at higher risk for pneumonia?
  • Do I have bacterial, viral, or fungal pneumonia? Whats the best treatment?
  • Am I contagious?
  • How serious is my pneumonia? Will I need to be hospitalized?
  • What can I do at home to help relieve my symptoms?
  • What are the possible complications of pneumonia? How will I know if Im developing complications?
  • What should I do if my symptoms dont respond to treatment or get worse?
  • Do we need to schedule a follow-up exam?
  • Do I need any vaccines?

Complications In Nosocomial Pneumonia

Failure to successfully wean the patient from the respirator is a common problem following intubation for nosocomial pneumonia.

HSV-1 pneumonitis develops in intubated patients who have unchanging or persistent pulmonary infiltrates after 2 weeks of antimicrobial therapy. These patients usually have low-grade fevers with variable degrees of leukocytosis. Demonstrating HSV-1 in samples of respiratory secretions may establish the diagnosis.

Start treatment with acyclovir in patients diagnosed with HSV-1 infection acyclovir decreases hypoxemia and subsequently permits weaning of the patient from the respirator.

Contributor Information and Disclosures

Kartika Shetty, MD, FACP Program Director, Internal Medicine Residency Program, Sunrise GME Facility Medical Director, TEAMHealth, Mountain View HospitalKartika Shetty, MD, FACP is a member of the following medical societies: American College of Physicians, Association of Program Directors in Internal Medicine, Medical Council of IndiaDisclosure: Nothing to disclose.

Maycky Tang, DO Resident Physician, Department of Internal Medicine, Sunrise Health GME ConsortiumMaycky Tang, DO is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Osteopathic AssociationDisclosure: Nothing to disclose.

Nazanin Sheikhan, MD Resident Physician, Department of Internal Medicine, Sunrise Health GME Consortium

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Can Pneumonia Be Prevented

Vaccinations can help prevent some types of pneumonia. Its a good idea to speak to your doctor about whether vaccination is recommended for you or for your children.

One vaccination that reduces the risk of pneumonia is the pneumococcal vaccine. Pneumococcal vaccines are free in Australia under the National Immunisation Program for some people .

Covid Pneumonia: How Long Does Recovery Take

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You’re likely familiar with the common, mild symptoms of COVID-19 including fever, dry cough and fatigue.

But, in more severe cases, COVID-19 can also cause serious complications, including pneumonia.

“We still have a lot to learn about COVID-19, particularly about the havoc it can wreak on the lungs and the pneumonia it causes, which is often now called COVID pneumonia,” says Dr. Rayman Lee, pulmonologist at Houston Methodist.

That being said, there’s still plenty that experts like Dr. Lee do know about COVID pneumonia, including about how long it can take to fully recover from it.

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How Is Pneumonia Spread From Person To Person

  • Pneumonia is spread when droplets of fluid containing the pneumonia bacteria or virus are thrown into the air when someone coughs or sneezes and is then inhaled by others. You can also get pneumonia by touching an object previously touched by the person with pneumonia or by touching a tissue used by the infected person and then touching their mouth or nose.
  • What Can I Do At Home To Feel Better

    In addition to taking any antibiotics and/or medicine your doctor prescribes, you should also:

    • Get lots of rest. Rest will help your body fight the infection.
    • Drink plenty of fluids. Fluids will keep you hydrated. They can help loosen the mucus in your lungs. Try water, warm tea, and clear soups.
    • Stop smoking if you smoke and avoid secondhand smoke. Smoke can make your symptoms worse. Smoking also increases your risk of developing pneumonia and other lung problems in the future. You should also avoid lit fireplaces or other areas where the air may not be clean.
    • Stay home from school or work until your symptoms go away. This usually means waiting until your fever breaks and you arent coughing up mucus. Ask your doctor when its okay for you to return to school or work.
    • Use a cool-mist humidifier or take a warm bath. This will help clear your lungs and make it easier for you to breathe.

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    Where And How Do Droplets Containing Bacteria Get Into The Air You Breathe

    Bacteria-containing droplets are produced when someone carrying the bacteria breathes, coughs, sneezes, speaks, or sings into the air that you breathe. Unlike the coronavirus that causes COVID-19 pneumonia, bacteria that cause community-acquired pneumonia are everywhere in the community. There are many carriers of community-acquired pneumonia that are not sick. The exact percentages of people in any population that carry common pneumonia-causing bacteria vary significantly, but based on different studies, it may range from 5% to 20% of the population.

    People that are sick from pneumonia represent only a small fraction of people that can transmit pneumonia-causing bacteria. That is why we dont recommend isolating people with community-acquired bacterial pneumonia. Avoiding exposure to pneumonia-causing bacteria is very difficult, and it is not an effective way to prevent pneumonia.

    Being exposed to pneumonia-causing bacteria is only the first step towards getting pneumonia. Most people that inhale droplets with bacteria dont get sick. Since it is not practical to avoid inhaling droplets with pneumonia-causing bacteria, the prevention of pneumonia is focused on other steps necessary to get pneumonia.

    Is Pneumonia Contagious

    Pneumonia patients at Siaya District Hospital
  • The germs that cause pneumonia are contagious. This means that they can be passed from person to person. By inhaling airborne droplets from sneezing or coughing, both viral and bacterial pneumonia can be transferred to others. This type of pneumonia can be transmitted by coming into contact with bacteria or viruses that cause pneumonia on surfaces or objects. Fungal pneumonia can be contracted from the environment. It is not, however, passed on from person to person.
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    How Long Does It Last

    It takes a certain amount of time to start to feel sick after getting exposed to a germ. This length of time is called the incubation period, and it depends on many things, especially which bug is causing the illness.

    With influenza pneumonia, for example, someone may become sick as soon as 12 hours or as long as 3 days after exposure to the flu virus. But with walking pneumonia, a person may not feel it until 2 to 3 weeks after becoming infected.

    Most types of pneumonia clear up within a week or two, although a cough can linger for several weeks more. In severe cases, it may take longer to completely recover.

    Page 2

    Your Lungs Get Filled Up With Pus And Gunk Due To The Battle Between White Blood Cells And Bacteria Leading To Pneumonia

    Unfortunately, the immune system is not always able to get rid of bacteria. When bacteria continue to grow inside your lungs, your immune system becomes overwhelmed. It starts to produce too many inflammatory chemicals. These chemicals help kill bacteria, but they also damage the lungs.

    When you reach this stage, you get pneumonia. Large numbers of white blood cells accumulate inside your lungs to continue the fight with bacteria. Lots of fluids accompany white blood cells, and affected air sacs get filled up with a pus-like fluid. At this point, these fluid-containing air sacs can be seen as white areas on a chest x-ray. You are now diagnosed with pneumonia.

    This is how you get pneumonia. It takes several steps after inhaling pneumonia-causing bacteria. It is difficult to avoid inhaling bacteria because they are present everywhere instead, these steps help prevent pneumonia:

  • Stop smoking
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    What Is The Recovery Time For Covid Pneumonia

    Dr. Lee: Regardless of what causes it, regaining strength after pneumonia can take quite a long time from several weeks to many months.

    During COVID pneumonia recovery, your body first has to repair the damage caused to the lungs then it has to deal with clearing leftover fluid and debris and, finally, scarring until the tissue is fully healed over all of which come with unpleasant symptoms.

    For the 15% of infected individuals who develop moderate to severe COVID-19 and are admitted to the hospital for a few days and require oxygen, the average recovery time ranges between three to six weeks.

    For the 5% who develop severe or critical illness, recovery can take much longer.

    Everyone’s recovery is unique and depends on:

    • Your overall health
    • Whether you have preexisting conditions
    • The severity of your infection

    If you are recovering from COVID pneumonia and experiencing persistent problems, I recommend seeing your doctor for a follow-up evaluation. If your recovery is prolonged, he or she may recommend a specialized program, such as pulmonary rehabilitation, to help get you back on track.

    In some cases, patients will have lingering symptoms after the initial COVID-19 infection, often called post-COVID syndrome. These “long haulers” can have variety of problems, since the virus can attack not only the lungs, but also the heart, kidneys and brain. Your doctor can also help you manage these lingering symptoms.

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    How Do Bacteria Responsible For Causing Pneumonia Get Inside Your Airway

    Pneumonia: Treatment: Hospital patients

    The short answer is: You breathe in droplets containing bacteria.

    The bacteria that causes community-acquired bacterial pneumonia is very common in the community. Most people who inhale droplets containing this bacteria do not get pneumonia. The droplets simply settle down inside the nose and upper airway. The bacteria colonize the upper airway. Your immune system then attacks these bacteria. After that, your immune system either gets rid of them or prevents them from invading any further. If your immune system doesnt completely eliminate them, instead restricting them to your upper airway, you become a carrier of bacteria.

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    Why Is There A Greater Risk Of Complications In A Hospital

    Pneumonia generally has no complications in young, otherwise healthy people. People in hospitals and retirement homes are often older, bedridden or weakened as a result of disease or surgery. That is why they more frequently develop severe pneumonia with complications. That risk is particularly high in patients who become infected with pneumonia while receiving artificial respiration.

    Should You Be Hospitalized For Pneumonia

    Not all adults with pneumonia need hospitalization. It is important to understand why hospitalization is necessary in only certain situations. There are guidelines and criteria doctors use to make that decision but it basically come down to how sick you are. If you would like to know what kind of symptoms you need to watch out for when you are concerned about pneumonia, you may read Pneumonia symptoms based on type and severity.

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    Pleural Effusions Empyema And Pleurisy

    There are two layers of tissue surrounding your lungs called the pleura. One wraps around the outside of your lungs and the other lines the part of your chest where your lungs sit. They help your lungs move smoothly when you breathe.

    If your pneumonia isn’t treated, the pleura can get swollen, creating a sharp pain when you breathe in. If you don’t treat the swelling, the area between the pleura may fill with fluid, which is called a pleural effusion.

    If the fluid gets infected, it leads to a problem called empyema. Tell your doctor if you are having any of these symptoms:

    • Hard time breathing
    • You don’t want to breathe deeply because it hurts

    Your doctor may look for swelling or fluid with an X-ray, ultrasound, or CT scan. They might also give you an electrocardiogram to make sure that a heart problem isn’t the cause of your chest pain.

    If you do have pleurisy, you may need medications that can stop the swelling.

    For pleural effusions and empyema, your doctor may suggest a procedure that removes fluid from your body with a needle. Antibiotics are also an option to treat empyema.

    Epidemiology Of Nosocomial Pneumonia

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    Incidence in the United States

    Nosocomial pneumonia accounted for 22% of all hospital infections in the United States. It is the second most common infection in hospitalized patients, and the most common infection in the intensive care unit responsible for one-fourth of all ICU infections.

    International incidence

    The international incidence and prevalence of nosocomial pneumonia is similar to that in the United States, with comparable rates of responsible microorganisms.

    Racial and sexual predilections

    Nosocomial pneumonia has no racial or sexual predilection.

    Age predilection

    Nosocomial pneumonia is most common in elderly patients however, patients of any age may be affected.

    Morbidity and mortality in hospital-acquired pneumonia and ventilator-associated pneumonia

    Intubation and ventilatory support bypass the normal host defense mechanisms, predisposing patients with ventilator-associated pneumonia to infection.

    In addition, hospital-acquired pneumonia /VAP that develops in ICU patients is associated with high morbidity and mortality rates, because these patients are already critically ill. Estimated all-cause mortality is between 25-50%.

    Compromised cardiac and lung function may further decrease their cardiopulmonary reserve.

    Ventilator-associated barotrauma often decreases already compromised lung function. In addition, it may alter chest radiographic appearances.

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    Things You Should Know About Pneumonia

    Pneumonia is an infection that causes the air sacs in the lungs to fill up with fluid or pus, which makes it harder to breathe. The most common symptoms are cough that may be dry or produce phlegm, fever, chills and fatigue. Other symptoms may include nausea, vomiting, diarrhea, and pain in the chest. and shortness of breath. Signs that indicate a more severe infection are shortness of breath, confusion, decreased urination and lightheadedness. In the U.S., pneumonia accounts for 1.3 visits to the Emergency Department, and 50,000 deaths annually.

    With the COVID-19 pandemic continuing to affect people around the world, pneumonia has become an even larger health concern. Some people infected with the COVID-19 have no symptoms, while others may experience fever, body ache, dry cough, fatigue, chills, headache, sore throat, loss of appetite, and loss of smell.

    The more severe symptoms of COV-19, such as high fever, severe cough, and shortness of breath, usually mean significant lung involvement. The lungs can be damaged by overwhelming COVID-19 viral infection, severe inflammation, and/or a secondary bacterial pneumonia. COVID-19 can lead to long lasting lung damage.

    Here are other important facts you should know about pneumonia:,

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