Complications of pneumonia Flashcards
what may be the general complications of pneumonia ?
- respiratory failure
- hypotension
- sepsis
- jaundice
what could the local complications of pneumonia be ?
- atrial fibrillation
- pleural effusion
- empyema
- lung abscess
- pericarditis and myocarditis
what type of respiratory failure is it and why?
type 1 -
Type I respiratory failure occurs because of damage to lung tissue. This lung damage prevents adequate oxygenation of the blood (hypoxaemia); however, the remaining normal lung is still sufficient to excrete the carbon dioxide being produced by tissue metabolism.
what is the treatment for respiratory failure?
high flow oxygen - 60%
- transfer the patient to ICU is hypoxia does not improve with O2 therapy or PaCO2 rises to above 6 kilopascals
take care with COPD
why may patients be hypotensive?
ma be due to a combination of dehydration and vasodilation due to sepsis.
what is the treatment for hypotension?
If systolic BP is 90mmHg. If systolic BP remains
what is the treatment for atrial fibrillation?
is quite common, particularly in the elderly. It usually resolves
with treatment of the pneumonia. -blocker or digoxin may be required to
slow the ventricular response rate in the short term.
how does pleural effusion develop from pneumonia
PE is fluid in the pleural space.
It results from inflammation of the pleura by adjacent pneumonia, causing fluid. If the fluid accumulates faster than it is reabsorbed a PE develops
what is the treatment for PE?
If this is small it may be of no consequence.
If it becomes large and symptomatic, or infected (empyema), drainage is
required
how common is PE?
effusions commonly occur with pneumonia and complicate around one-third to a half of all CAP cases
the majority of these are simple exudative effusions but empyema may also develop.
what is an empyema?
pus in the pleural space.
what are the indications of empyema?
- ongoing fever
- rising or persistently high inflammatory markers, despite appropriate antibiotic treatment
what are the clinical features of empyema?
CXR indicates pleural effusion
The aspirated pleural fluid is typically yellow and turbid with a pH
what should be done if there is a PE?
- thoracocentesis should be performed to make a diagnosis
- using ultrasound, fluid should be aspirated and sent for a gram-stain, culture, fluid, protein, glucose and LDH
- lights’s criteria should be use to assess whether the effusion is transudative or exudative
what should be done if an empyema develops ?
- fluid should be urgently drained
- the duration of antibiotic administration will usually need to be extended
- thoracic surgery if severe
what is a lung abscess ?
a cavitating area of localised, suppurative infection within the lung
it often comes under the same differential diagnosis as cancer and TB
- it can come from smoking too
what causes lung abscess?
- inadequately treated pneumonia
- aspiration
- bronchial obstruction (tumour, foreign body)
- pulmonary infarction
- septic emboli (septicaemia, right heart endocarditis, IV drug use)
- subphrenic or hepatic abscess
what are the clinical features of lung abscess?
- persisting or worsening pneumonia
- large quantities of sputum - which is often foul smelling
- usually have a swinging fever, malaise and weight loss
what may be found on examination of lung abscess ?
clubbing ay occur in chronic suppuration
- patients may have normocytic anaemia and/or raised inflammatory markers
- may have crepitations
what tests are done for lung abscess?
blood tests : FBC for anaemia and neutrophilia, ESR, CRP, blood cultures
sputum microscopy, culture and cytology
CXR, CT
need to do a bronchoscopy
what would be observed in a lung abscess CXR?
walled cavity, often with a fluid level
why is a CT done for lung abscess?
to exclude obstruction, and bronchoscopy to obtain diagnostic specimens
what is the treatment for lung abscess?
- should be guided by available culture or clinical judgement
- continue antibiotics until healed (4-6 weeks)
- may need surgical drainage
how does septicaemia arise?
may occur as a result of bacterial spread from the lung parenchyma
into the bloodstream.
what may septicaemia cause?
may cause metastatic infection, e.g. infective endocarditis, meningitis
what is septicaemia treated with?
IV antibiotics according to sensitivities
how is jaundice a complication of pneumonia ?
this is usually cholestatic and may be due to sepsis or secondary to antibiotic therapy
