complications of pneumonia

Question 1

what are the main complications of pneumonia

[RAPHE L.O]

Answer 1

• Resp failure
• AF
• Pleural effusion
• Hypotension
• Empyema
• Lung abscess
• Other complications

– sepsis, pericarditis/myocarditis/jaudice

Question 3

resp failure

Answer 3

Respiratory failure

 Type 1: PaO2 <8kPa + PaCO2 <6kPa

• Rx: high flow 02

 Type 2: PaO2 <8kPa + PaCO2 >6kPa

• transfer to itu if hypercapnic
• considere elective ventilation if rising hypercapnia/worsening acidosis

Mx = o2 therapy, ventilation

[aim to keep sa02 at 94-98% and pa02 >8kPA]

[nb. be careful with o2 therapy in COPD pts, target range 88-92%]

Question 4

AF

Answer 4

• common esp in elderly

tends to resolve once pneumonia is treated

mx: digoxin/Bb for rate control

Question 5

pleural effusion

Answer 5

inflammation of pluera by adjacent pneumonia may cause flid exudation into pleural space - if accumulates faster than is reasbsorbed, get plueral effusion

Mx: tap and send for mc+s, cytology, chemistry

Question 6

hypotension

Answer 6

cause: dehydration + septic vasodilation

mx:

if sbp <90 - 250ml fluid challenge over 15 mins

if no improvement: central line + IV fluids

if refractory: send to itu for inotropes [beta1 receptor agonists]

Question 7

empyema

Answer 7

= pus in pleural cavity/space

aneaerobes and gram -ve

associated w/recurrent aspiration

pt w/ resolving pneumonia develops recurrent fever

tap: turbid, ph <7.2, low glucose, high LDH, typically yellow fluid

mx: us guided chest drain + abx

Question 8

lung abscess

Answer 8

= cavitating areas of localised, suppurative infection within the lung

Causes

 Aspiration

 Bronchial obstruction: tumour, foreign body

 Septic emboli: sepsis, IVDU, RH endocarditis

 Pulmonary infarction

 Subphrenic / hepatic abscess

inadequetly treated pneumonia

Features

 Swinging fever

 Cough, foul purulent sputum, haemoptysis

 Malaise, wt. loss

 Pleuritic pain

 Clubbing

 Empyema

Tests

 Blood: FBC[neutrophillia/anemia], ESR, CRP, cultures

 Sputum: micro, culture, cytology

 CXR: cavity c¯ fluid level

 Consider CT [to exclude obstruction] and bronchoscopy [to obtain diagnostic specimens]

Mx

 Abx according to sensitivities, continue till healed [4-6wks]

 Aspiration of empyema/abscess

 Surgical excision

postural drainage [chest physio]

Question 9

other complications

Answer 9

1.sepsis

• septicemia- bacterial spread from lung parenchyma

2. pericarditis/myocarditis

• cay complicate pneumonia

3. jaundice

• usually cholestatic
• causes: sepsis, drugs [fluclox/augmentin], mycoplasma, legionella