What is the Meaning of Hospital Acquired Pneumonia?
Hospital Acquired Pneumonia is a potentially serious and at times lethal medical condition which a patient develops while he or she is admitted in the hospital for treatment of some other medical condition. This condition normally develops within a couple of days after being admitted to the hospital. This condition is mainly caused by bacteria which infiltrate the already compromised body mechanism of which the most common pathogens being gram-negative bacilli and Staphylococcus aureus. During the initial phases of this condition, the patient may complain of malaise or lethargy. The patient may also exhibit mental status changes. The patient can also have fever, chills, rigor, cough, shortness of breath, and chest pain. In case if the patient is intubated or in mechanical ventilation it is caused by poor oxygenation and ever increasing tracheal secretions. This condition is more common in people who are in the Intensive Care Unit or ICU as they already have a severely compromised immune system and are easily attacked by the pathogens. The diagnosis of Hospital Acquired Pneumonia can be made on the basis of symptoms observed, chest x-ray and blood tests. As stated above, Hospital Acquired Pneumonia is more often quite a serious medical condition and the overall prognosis is quite poor.
Why do Patients Acquire Pneumonia in ICU?
If a patient is in the ICU, then he or she may develop Pneumonia because of the following reasons:
- Having a severely compromised immune system which is not able to tackle the pathogens
- The germs and bacteria present in the surrounding of the ICU are more lethal and dangerous than which are present in the outside environment
- ICU Patients who are on a ventilator or mechanical respirators are more at risk for developing Pneumonia.
- Germs can also be transmitted through clothes or hands of nurses, doctors, or relatives of the patient who visit them in ICU even though all care is taken to avoid such situations
- Also people, who have had a history of alcohol abuse, have had a procedure to the chest or any other vital organ of the body are prone to get Pneumonia while recuperating in the ICU.
- The elderly populations are also at risk for having pneumonia while in the ICU.
When is Pneumonia more likely to Occur in a Patient Admitted in ICU?
It is seen that Pneumonia is most likely to occur in ICU patients who are intubated or use a mechanical ventilator with the percentage being approximately 80%. This happens because the intubation breaks through the airway defenses, comes in the way of clearing cough and mucous thus allowing in a way accumulation of bacteria above the cuff of the tube of the ventilator. Such bacteria form a film within the tube which gives them added protection from any type of antibiotics thus making them that much more dangerous. When it comes to patients who are not on mechanical ventilators or in other words are not intubated Pneumonia can develop due to previous antibiotic treatments, existing cardiac, pulmonary, or renal dysfunctions.
What are the Symptoms that may indicate Development of Pneumonia in a Patient in ICU?
For patients who are not intubated, the symptoms and signs of Pneumonia includes malaise, fever, chills, rigor, cough, shortness of breath, and chest pain. For patients who are critical and intubated include fever and changes in the respiratory measurements along with hypoxemia.
What can be done to Diagnose Pneumonia in a Patient in ICU?
Some of the tests to confirm the presence of Pneumonia in a patient admitted in the ICU are:
- ABG for measurement of oxygen level in blood
- Blood cultures to make sure that the infection has not spread
- Chest x-ray
- Pulse oximetry
- Sputum culture to identify the pathogen causing the pneumonia.
How is Hospital Acquired Pneumonia Treated?
The following are the treatment strategies adopted for treating pneumonia in patients admitted in the ICU or Hospital Acquired Pneumonia:
Empiric use of antibiotics which can be potent against resistant organisms. The antibiotic is chosen based on the following:
- Local sensitivity pattern
- Risk factors of the patient for antibiotic resistant pathogens.
Some of the medications used for treating pneumonia in patients who do not have other risk factors are:
Medications used for treating pneumonia in patients who have other risk factors are cephalosporin, carbapenem, piperacillin, fluoroquinolone, vancomycin.
It should be noted here that excessive use of antibiotics may result in antimicrobial resistance but if initial empiric doses of antibiotics are adequately given then the results may be more favorable. Hence it is vital that the treatment begins initially with broad spectrum antibiotics and then pinning down to the best antibiotic which can help the patient depending on the response of the patient.
What is the Overall Prognosis for Patients who have Developed Pneumonia in the ICU or Hospital Acquired Pneumonia?
As stated above, if a patient admitted in the ICU develops pneumonia then it can be a potentially life threatening phenomenon and more often than not prognosis is poor, especially for patients who are intubated. Even if the patient recovers from the pneumonia he or she may end up with significant damage to the lungs due to Pneumonia.