Post-Op Pneumonia Flashcards
(49 cards)
What is pneumonia defined as?
A lower respiratory tract infection with accompanying consolidation visible on CXR
What are the main types of pneumonia?
- HAP
- CAP
- Aspiration
- Immunocompromised (opportunistic)
What is the predominating type of pneumonia in a post-op setting?
HAP
What is HAP?
Pneumonia with onset >48 hours since hospital admission and was not present on admission
Why are surgical patients predisposed to developing lower respiratory tract infections?
- Reduced chest ventilation
- Change in commensals
- Debilitation
- Intubation
Why do post-op patients have reduced chest ventilation?
Reduced mobility in bedridden patients results in an inability to fully ventilate their lungs, leading to accumulation of fluid secretions which subsequently become infected
Why is there a change in commensals in post-op patients?
The hospital environment microflora will vary compared to what the patient may normally be exposed to, nor have immunity too
What are the common pathogens for HAP?
- E. coli
- S. aureus, including MRSA
- S. pneumonia
- Pseudomonas
What is meant by debilitation in post-op patients?
Many patients undergoing surgery are likely to be sick or have several co-morbidities, compromising their immune systems and predisposing to pulmonary infections
What is VAP?
Ventilator acquired pneumonia
HAP that occurs >48 hours after tracheal intubation
How common is VAP, compared to other healthcare infections?
It is the most common hospital acquired infection in patients receiving mechanical ventilation, accounting for around 50% of antibiotics given in an ICU setting
Who is VAP most common in?
Those with ET tube in situ
Why is VAP most common in those with ET tube in situ?
As the tube interferes with normal protective upper airway reflexes, prevents effective coughing, and encourages aspiration of contaminated pharyngeal contents
What are the risk factors for developing HAP?
- Age
- Smoking
- Known respiratory disease or recent viral illness
- Poor mobility
- Mechanical ventilation
- Immunosuppression
- Underlying co-morbidities, e.g. diabetes, cardiac disease
What is the classical presentation of HAP?
- Productive or non-productive cough
- Dyspnoea
- Chest pain
Why might patients with HAP not present in the classical way?
- Intubation
- Reduced consciousness
- Other co-morbidities
What might be the only clinical features of HAP in some patients?
- General malaise
- Pyrexia
- Impaired cognition
What may be found on examination in HAP?
- Reduced O2 saturation
- Increased RR or HR
- Pyrexial
- Features of septic response
What may be found on auscultation in HAP?
- Bronchial breath sounds
- Inspiratory crackles
- Dull percussion notes
What are the differential diagnoses for HAP?
- Acute heart failure
- Acute coronary syndrome
- PE
- Asthma or COPD exacerbation
- Pleural effusion or empyema
- Psychological, e.g. anxiety disorder
What investigations may be done in HAP?
- Bloods
- ABG
- Sputum sample
- Blood cultures
- Imaging
What bloods may be done in HAP?
- FBC
- CRP
- U&Es
When might an ABG be required in HAP?
In severe cases of oxygen desaturation
When should blood cultures be done in HAP?
If there are any signs of severe infection or sepsis
