PNA and ARDS (and Pleural Effusions) Flashcards
what are some of the major risk factors for CAP?
lifestyle factors and previous episode of PNA
what are some of the risk factors for HAP?
male sex, malnutrition, burns, trauma, and post surgery
who is at risk for aspiration PNA?
impaired swallowing, impaired consciousness, stroke patients
what are the factors that lead the transition from colonization to infection?
host factors: defenses impaired, chronic lung disease, preceding infection, abnormal lung microbiota; pathogen factors: large inoculum, highly virulent microorganism
once a LRTI has occurred the maintenance of lung homeostasis depends on an adequate balance between what?
immune resistance and tissue resilience
what are the most frequent pathogens causing HAP and VAP?
p. aeruginosa and s. aureus
what is the main concern in HAP and VAP?
antibiotic resistance is the main concern
what pathogens are most likely to cause aspiration PNA?
anaerobes and gram negative bacilli (e.coli, k. pneumoniae, and p. aeruginosa)
symptom burden does not predict outcome nor etiology in pna. What are the exceptions to this statement?
delirium: increased risk of mortality; pleuritic chest pain: increased risk of pleural effusion
what are the steps of diagnosing PNA?
- pt has acute onset of symptoms of LRTI 2. New infiltrates on CXR 3. microbiology tests/influenza test/ COVID-19 test/ CBC/CMP/ CRP/ procalcitonin
what kind of microbiology tests are performed in patients with PNA admitted to the ward?
gram stain, sputum culture and urinary antigen test
what kind of microbiology tests are performed in ICU patients with PNA?
gram stain, sputum culture, blood culture, urinary antigen tests, and PCR for respiratory viruses
how do you treat non-severe CAP?
b-lactam +macrolide
or
respiratory fluoroquinolone
how do you treat severe CAP?
b-lactam + macrolide
or
b-lactam + respiratory fluroquinolone
what happens if you have a patient with severe CAP and they were recently hospitalized, on parenteral antibiotic, and they are at risk for MRSA infection?
add mrsa coverage like vancomycin
what would you do if you had a patient with severe CAP, they were recently hospitalized, on parenteral antibiotic, and at risk for pseudomonas infection?
add pseudomonas coverage like piperacillin-tazobactam
how would you treat a patient if you are concerned for aspiration?
same agents, but if they have poor dentition- then we also want to add a broad coverage b-lactam like ampicillin-sulbactam or a quinolone
what are the complications associated with PNA?
cardiovascular disease–> new or worsening heart failure, new or worsening arrhythmias, and acute coronary syndromes
how do you manage severe cases of covid-19 PNA?
dexamethasone, remdesivir, and cytokine inhibitors
what is the normal amount of fluid that should be in the pleural space?
.1 mL per kg
what are the 6 most common conditions associated with pleural effusions?
heart failure, bacterial PNA, pulmonary embolism, malignancy, viral disease, post-cardiac surgery
how might a pleural effusion caused by heart failure present?
hypoxia, pulmonary/peripheral edema
what might the physical look like in a patient with a pleural effusion?
decreased breath sounds at the base of the affected lung; dullness to percussion is sensitive and specific for diagnosing effusion
what physical exam finding would be diagnostic of a pleural effusion?
dullness to percussion
what imaging modality is used to diagnose a pleural effusion?
CXR: PA 200 mL and lateral: 50 mL
what is pleural fluid routinely tested for?
protein, lactate dehydrogenase, gram staining and culture, cytology, pH level, glucose
what is light’s criteria used for?
99.5% sensitive for diagnosing exudative effusion and differentiate exudative from transudative effusions
what are light’s criteria? (3)
pleural fluid protein to serum protein ratio >.5
pleural fluid LDH to serum LDH ratio >.6
pleural LDH >.67 x upper limit of normal for serum LDH
what is ARDS?
rapidly progressive noncardiogenic pulmonary edema
what are some of the major risk factors for ARDS?
older age, alcohol abuse, cigs, air pollution, hypoalbuminemia, trauma, disparities in gender and ethnicity
what is the treatment for ARDS?
supportive; oxygen and positive pressure ventilation
what are the rescue therapies used to treat ARDS?
nitric oxide, ECMO or CO2 removal, glucocorticoids
