Pneumonia

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Pneumonia
ICD-9 480

-486

Pneumonia is defined as "inflammation of the lungs."[1]

Classification

Pneumonia can be classified along various dimensions including clinical setting, underlying etiology, and its gross appearance (bronchopneumonia versus lobar pneumonia).

Aspiration pneumonia

Community acquired pneumonia

Atypical pneumonia

Nosocomial pneumonia

Ventilator associated pneumonia

Diagnosis

A clinical prediction rule found the five following signs best predicted infiltrates on the chest radiograph of 1134 patients presenting to an emergency room:[2]

  • Temperature > 100 degrees F (37.8 degrees C)
  • Pulse > 100 beats/min
  • Crackles
  • Decreased breath sounds
  • Absence of asthma

The probability of an infiltrate in two separate validations was based on the number of findings:

  • 5 findings - 84% to 91% probability
  • 4 findings - 58% to 85%
  • 3 findings - 35% to 51%
  • 2 findings - 14% to 24%
  • 1 findings - 5% to 9%
  • 0 findings - 2% to 3%

A subsequent study[3] comparing four clinical prediction rules to physician judgment found that two clinical prediction rules, the one above[2] and another[4] were more accurate than physician judgment because of the increased specificity of the prediction rules.

Treatment

Antibiotics

Aspiration pneumonia

Community acquired pneumonia

The optimal duration of antibiotic treatment for community acquired pneumonia is not clear.[5]

Ventilator associated pneumonia

Treatments that are ineffective

Chest physiotherapy includes postural drainage, percussion, and vibration and has been call the 'ketchup-bottle method'[6] of treating pneumonia. Chest physiotherapy and intermittent positive-pressure breathing have been shown not to help in a small randomized controlled trial.[7]

Prognosis

Short term prognosis and the decision to hospitalize

The prognosis of community acquired pneumonia can be estimated with the pneumonia severity index (PSI) and CURB-65 clinical prediction rules. The PSI may be the most accurate.[8]

Long term prognosis

References

  1. Anonymous (2024), Pneumonia (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 Heckerling PS, Tape TG, Wigton RS, et al (1990). "Clinical prediction rule for pulmonary infiltrates". Ann. Intern. Med. 113 (9): 664–70. PMID 2221647[e]
  3. Emerman CL, Dawson N, Speroff T, et al (1991). "Comparison of physician judgment and decision aids for ordering chest radiographs for pneumonia in outpatients". Annals of emergency medicine 20 (11): 1215–9. DOI:10.1016/S0196-0644(05)81474-X. PMID 1952308. Research Blogging.
  4. Gennis P, Gallagher J, Falvo C, Baker S, Than W (1989). "Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgenograms in the emergency department". The Journal of emergency medicine 7 (3): 263–8. PMID 2745948[e]
  5. Li JZ, Winston LG, Moore DH, Bent S (2007). "Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis". Am. J. Med. 120 (9): 783–90. DOI:10.1016/j.amjmed.2007.04.023. PMID 17765048. Research Blogging.
  6. Murray JF (1979). "The ketchup-bottle method". N. Engl. J. Med. 300 (20): 1155–7. PMID 431639[e]
  7. Graham WG, Bradley DA (1978). "Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia". N. Engl. J. Med. 299 (12): 624–7. PMID 355879[e]
  8. Aujesky D, Auble TE, Yealy DM, et al (2005). "Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia". Am. J. Med. 118 (4): 384-92. DOI:10.1016/j.amjmed.2005.01.006. PMID 15808136. Research Blogging.

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