Voiceover: When youhear the term pneumonia, I think that most of usthink about lung infection, but not much else besides that. Pneumonia really is a little bit more than just a lung infection, really in relation to where it is. As we're looking at this image here I want to focus on thelungs that I've drawn out.
We know that we have aright and a left lung. Our right lung, I'm just going to draw out some lobes here, we know that we've got three lobes in our right lung, so we have an upper, a middle, and a lower. In our left we've got two. We know that we have an airway,
so our main airway. Now don't focus on this yellow line yet. Just focus on our main airway. We know that we breathe in air, and that air is going to travel down through these smaller branches, these branches that branch off. At the end of our airway,
we have these little grapelike sacs. I'm just going to draw a couple just right here so we can see. These little grapelikesacs are actually air sacs, and we call those aveoli. The alveoli is really important because that's where thegas exchange happens. This is where ultimately the oxygen
is going to end up, and where we'll pick up carbon dioxide to exhale out. Why is this importanté When we talk about pneumonia, the pneumonia, the infection, is actually in these air sacs. What I'm doing is I'm drawing these sacs as if we could blow them up
millions and millions of times, because they're actually very, very tiny. We have millions of them everywhere at the end of our airways. So if we could blow them up, they'd look something like this. Now right underneath it, I'm going to just keep drawing the kind of structure
Managing Community Acquired Pneumonia in the ICU
Patient SK presented with increasingshortness of breath, rightsided chest pain, productive cough in a change in level ofconsciousness she was febrile with an O2 sat ofeightythree percent on room air; she had an elevated white blood cell countand on chest xray there was a consolidation. SK was intubated and transferred tothe ICU. Blood cultures were sent and antibioticswere administered.
She is diagnosed with Communityacquiredpneumonia or CAP. In Canada, pneumonia (including influenza) is the eighth most common cause of death. A third of patients with CAP are admittedto the ICU where mortality rates range from 20 to50 percent. Like all ammonia syndromes the diagnosisis based on the appropriate constellation of al signs and symptoms.
Blood and sputum cultures should be sent for anypatient with CAP sick enough to be admitted to the, especially the ICU, but they are often negative. Therefore, antimicrobial therapy is oftenempiric for the entire course of treatment. It is important to target therapy tomost likely pathogens, current resistance rates and where possible, known, recent,
antibiotic use. The key pathogens to consider in CAPinclude Streptococcus pneumoniae, and Haemophilus influenza and in the ICU Legionella species. Staph. aureus or or methicillinresistantStaph. aureus (MRSA) should be considered in apatient with known colonization or risk factors. During flu season, influenza A B are notable causes of pneumonia.
Surveillance systems routinely monitorresistance in Strep pneumo and H. flu. Current macrolide resistance in Strep pneumois around 30 percent while penicillin and cephalosporinresistance is less than one percent and fluoroquinolone resistance isbetween one to two percent. Outpatient rates of ampicillin resistance in H. flu are roughly 18 percent. Therefore for SK a reasonable choicewould be a thirdgeneration cephalosporin
such as ceftriaxone or cefotaxime, plus a macrolide like azithromycin. The thirdgeneration cephalosporin willcover Strep pneumo, H. flu, and gramnegatives like E coli or Klebsiella pneumoniae. The macrolide will cover Legionella.During flu season, consider adding oseltamivir. Guidelines recommend either a macrolideor a fluoroquinolone for severe CAP.