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How Serious Is Sepsis And Pneumonia

What Are The Signs Of Double Pneumonia

Influenza and Sepsis: Mayo Expert Describes Warning Signs of Severe Sepsis, Septic Shock

Pneumonia is an infection of one or both sides of the lungs that causes the air sacs to fill up with fluid or pus, according to the National Heart, Lung, and Blood Institute . Pneumonia can be caused by a bacteria, virus, or fungus. Symptoms can vary, but may include the following:

  • Cough
  • Nausea, vomiting, or diarrhea
  • Fatigue

You can also develop complications of pneumonia, like septic shock, lung abscesses, renal failure, and respiratory failure, per the NHLBI.

Double pneumonia isnt an official medical term, but it usually refers to having pneumonia in both lungs, says Richard Watkins, M.D., an infectious disease physician and professor of internal medicine at Northeast Ohio Medical University.

It isnt necessarily more or less common than pneumonia that involves one lung, but it usually depends on the type of pneumonia a person has. Bacterial pneumonia more commonly involves one lung and viral often is a diffuse pattern in both lungs, Dr. Watkins says. X-rays and CT scans in patients with COVID-19 usually show both lungs are involved.

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What Are The Beginning Stages Of Sepsis

During the beginning stages of sepsis, you will know something is not right. Even if you catch the condition early, the infection is already serious. An individual who has sepsis may be showing signs of weakness or confusion. They may feel faint, and their breathing and heart rate may increase. If these signs are present, its time to seek emergency care .

Home » Frequently Asked Questions » Nursing Home Injury » What Are the 3 Stages of Sepsis?

What are the stages of sepsis? There are three levels of sepsis, and these include sepsis, severe sepsis, and septic shock. This is a life-threatening condition that occurs when a persons body goes into overdrive in response to an infection. Nursing home patients may experience any of these stages of sepsis as a result of nursing home abuse and neglect.

Read more about the stages of sepsis in order. Understanding the phases of sepsis and how the timeline of the condition works will help you identify it in your loved one.

Search Strategy And Selection Criteria

Studies were selected if they were published studies that assessed clinical predictors of community-acquired pneumonia without date restrictions to maximize the search. The first search was employed on Dec 4, 2017, with an update on Mar 5, 2018. Narrative review, letters to editors, case reports and case series were excluded. Studies were included if participants aged 18 years without serious illness and pre-existing immune suppression . To be eligible, studies had to have reference standard of CXR for diagnosing pneumonia, and have conducted in ambulatory care or primary care settings. Index tests assessed were patients socio-demographic, clinical signs and symptoms and laboratory tests.

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Symptoms During The Gray Hepatization Phase

This is the more severe phase of lobar pneumonia, and while you may not notice as much coughing or sputum production, shortness of breath is common. Your alveoli are surrounded by swelling and fibrous strands that keep them from moving gases like oxygen in and out of your bloodstream.

Medical emergency

You might have symptoms of hypoxia as your gas exchange is impaired. This is a life threatening emergency. Call emergency services or go to the nearest emergency room if you experience:

  • a blueish tinge to your lips or nail beds
  • severe shortness of breath
  • a rapid heartbeat
  • shallow breathing

In this stage, supplemental oxygen or even mechanical ventilation may be required to prevent additional complications from hypoxia.

Summary Of Key Results

Sepsis  when an infection becomes life threatening

In this study, we evaluated a large multi-center cohort of patients with pneumonia complicated by septic shock. Overall mortality was high in this population. There were 3048 patients who received appropriate antimicrobial therapy after the development of septic shock with a mean time to appropriate antimicrobial therapy of 10.9 h. Patients who died in the hospital were significantly older and had significantly higher APACHE II scores, number of organ failures, and admission serum lactate. Time to administration of appropriate antimicrobial therapy remained the most important predictor of in-hospital mortality in this population. In the training set , a CART model using APACHE II score, lactate, age, and time to appropriate antimicrobial therapy yielded predictive accuracy of 73%, specificity 75%, sensitivity 71%, and AUROC 0.75. In the testing set , the CART model offered predictive accuracy of 69%, specificity 72%, sensitivity 65%, and AUROC 0.72.

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How Serious Is Double Pneumonia

Pneumonia in any form is usually more serious for children under the age of five, adults over the age of 65, people with certain conditions like heart failure, diabetes, or chronic obstructive pulmonary disease , or people who have weakened immune systems, the NHLBI says.

Typically, double pneumonia is more serious for anyone, says Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, Calif. If you have one good lung, it can meet all of your bodys needs until your other lung recovers. But, if both lungs are involved, youre in a fragile situation, he explains.

That said, it depends on the person and how their body reacts. One small area of the lungs thats affected by pneumonia can be life-threatening if its extensive, says Reynold Panettieri, M.D., a lung specialist and vice chancellor for translational medicine and science at Rutgers University. Sometimes, double pneumonia is well tolerated.

How Long Does Sepsis Take To Kill

According to research from the University of Michigan Institute for Healthcare Policy and Innovation, sepsis can keep killing months later and in some cases even years later .

Patients who have pre-existing conditions are more likely to develop sepsis, and it is not known whether or not this is a contributing factor to the increased risk of death in the 30 days to two years after diagnosis.

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The Serious Effects Of Sepsis

Although sepsis is potentially life-threatening, the illness ranges from mild to severe. Theres a higher rate of recovery in mild cases. Septic shock has close to a 50 percent mortality rate, according to the Mayo Clinic. Having a case of severe sepsis increases your risk of a future infection. Severe sepsis or septic shock can also cause complications. Small blood clots can form throughout your body. These clots block the flow of blood and oxygen to vital organs and other parts of your body. This increases the risk of organ failure and tissue death .

Although some people have a higher risk of infection, anyone can get sepsis. People who are at risk include:

  • young children and seniors
  • people with weaker immune systems, such as those with HIV or those in chemotherapy treatment for cancer
  • people being treated in an intensive care unit
  • people exposed to invasive devices, such as intravenous catheters or breathing tubes

Can Sepsis Be Prevented

Life after sepsis: Health consequences among survivors of severe sepsis

To prevent sepsis, you should try to prevent getting an infection:

  • Take good care of any chronic health conditions that you have
  • Practice good hygiene, such as handwashing
  • Keep cuts clean and covered until healed

NIH: National Institute of General Medical SciencesCenters for Disease Control and Prevention

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Tests To Diagnose Sepsis

Sepsis is often diagnosed based on simple measurements such as your temperature, heart rate and breathing rate. You may need to give a blood test.

Other tests can help determine the type of infection, where it’s located and which body functions have been affected. These include:

  • urine or stool samples
  • a wound culture where a small sample of tissue, skin or fluid is taken from the affected area for testing
  • respiratory secretion testing taking a sample of saliva, phlegm or mucus
  • blood pressure tests
  • imaging studies such as an X-ray, ultrasound scan or computerised tomography scan

Severe Or Complicated Pneumonia

As you move into the red or gray hepatization phases of pneumonia, you may need to be treated with intravenous antibiotics or fluids. You may also require supplemental oxygen.

Medications used in more severe cases of pneumonia requiring inpatient care usually include formulas that combine more than one type of antibiotic, such as:

  • fluoroquinolones
  • cephalosporin
  • macrolides

Viral pneumonia caused by influenza may also require the use of oseltamivir, an antiviral medication, which is predominantly used to shorten the course of viral pneumonia.

In severe cases, you may also need direct drainage of fluids from your lungs with a chest tube.

A chest tube could be used if a person develops a parapneumonic effusion, which is not in the lungs but around the lungs in the thoracic cavity, which is also known as the pleural space.

You will be observed closely for any complications if you have other health conditions like:

  • kidney disease
  • cancer
  • other lung conditions

People with other conditions are more likely to have pneumonia that progresses to or multi-organ failure and even death.

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How Is Sepsis Diagnosed

The diagnose sepsis, your healthcare provider will look for a variety of physical finding such as low blood pressure, fever, increased heart rate, and increased breathing rate. Your provider will also do a variety of lab tests that check for signs of infection and organ damage. Since some sepsis symptoms can often be seen in other conditions, sepsis can be hard to diagnose in its initial stages.

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Who Is At Higher Risk For Developing The Infection

Sepsis Secondary To Pneumonia : Improve Clinical Documentation of ...

While anyone can develop pneumonia, some people are at higher risk than others. These include:

  • The elderly
  • People who recently had a cold or influenza
  • Smokers
  • Having a respiratory illness, such as chronic obstructive pulmonary disease
  • Exposure to certain inhaled toxins
  • Recent surgery
  • People in intensive care units

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What Is Aspiration Pneumonia

Aspiration pneumonia is pneumonia that is caused by something other than air being inhaled into your respiratory tract. These non-air substances can be food, liquid, saliva, stomach contents, toxins or even a small foreign object.

Theres also a condition called aspiration pneumonitis which is caused by the same type of thing happening but there is only inflammation and irritation, not infection. Its difficult to tell the two conditions apart.

Other names for aspiration pneumonia include anaerobic pneumonia, necrotizing pneumonia and aspiration of vomitus.

What Are The Signs Of Pediatric Sepsis

Part of the reason sepsis can turn into a serious condition is because it is difficult to detect early in children. For example, in adults, two of the telltale signs of sepsis include a rapid heartbeat and low blood pressure. Those symptoms look different in kids. Children have less cardiac reserve than adults and compensate differently, Dr. Kandil says, referring to the difference between the amount of blood a heart pumps at a given time and its maximum capacity for pumping blood. This means their blood pressure might decrease only much later in the sepsis process, she says.

On top of being difficult to recognize, sepsis is a secondary medical condition that develops after an initial infection, and its symptoms can mimic those of the original illness. Some signs of sepsis can include the following:

  • Fever
  • Lethargy or being sleepier than normal
  • General pain or discomfort
  • Dizziness
  • Dehydration

Unlike some medical conditions that produce consistent symptoms across the general populationthe flu virus, for examplesepsis symptoms can vary according to each individual, and this makes the value of diagnostic testing all the more important.

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How To Treat And Prevent Pneumonia

Pulse oximetry Measures the oxygen level in your blood and helps evaluate lung function.

Sputum culture test Examines a sample of your sputum to identify the bacteria, virus, or fungus that causes an infection.

Other imaging tests A CT scan or MRI looks for signs of infection throughout the body. For example, they may note swelling or inflammation in your head on a brain MRI, which could be a sign of meningitis. Your doctor can also diagnose meningitis by removing a sample of cerebral spinal fluid with a lumbar puncture procedure.

Throat culture To confirm or rule out strep throat as the underlying infection, your doctor may swab the back of your throat and check this sample for the strep bacteria.

Skin culture If you have an open wound, secretion from the wound or a skin sample can help diagnose cellulitis, staphylococcus aureus , or another skin infection.

Early Stage Of Pneumonia

C5a neutralization is protective in severe pneumonia

The symptoms of the first stage of pneumonia, or what you might expect in the first 24 hours, are very important to understand. When pneumonia is detected at this stage, and promptly treated, the severity of the disease and potential complications may be reduced.

Most commonly, lobar pneumonia begins suddenly with fairly dramatic symptoms.

With pneumonia , the tiniest airways of the lungs are affected. Since this is where the exchange of oxygen and carbon dioxide takes place , pneumonia may cause symptoms related to lower oxygen levels in the body. In addition, lobar pneumonia often extends to the membranes surrounding the lungs , which can lead to particular symptoms.

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Treatment And Prognosis Of Pneumococcal Sepsis

Pneumococcal sepsis is a serious medical condition where bacteria, specifically Streptococcus pneumoniae, infect the blood. The infection of the blood causes the immune system to react at full force and creates an inflammatory response as a counter attack to the bacterial infection. Although caused by the immune system itself, the inflammatory response comes with its own consequences and can cause further damage to the body resulting in permanent damage and possible shutdown of the internal organs.

Pneumococcal sepsis occurs in individuals who have weakened immune systems such as cancer patients, those infected with HIV, recent transplant patients, and those who are recovering from recent invasive surgical operations. Others at risk include young babies, elderly people, and diabetics. Healthy individuals with no prior history of immune system problems or other serious health issues rarely develop pneumococcal sepsis.

The transmission of the Streptococcus pneumoniae bacteria is spread through droplets from coughs or sneezes of infected individuals who are in close proximity to others. In airborne cases, Streptococcus pneumoniae, when inhaled through the lungs, will cause pneumonia. When the bacteria enter the body through a break in the skin, such as a wound or healing closure from a recent operation, sepsis can occur, especially if the individual is taking some kind of immune suppressing drug.

References

Management Of Patients With Sepsis And Cap

Early recognition and diagnosis allows prompt initiation of therapy . Sepsis and septic shock are medical emergencies and should be treated immediately. Resuscitation from sepsis hypoperfusion should be started with 30 ml/kg of IV crystalloid fluid within three hours . Hemodynamic assessment including cardiac functions should be performed dynamically, and additional fluid use should be guided by frequent reassessment of hemodynamic status, with the goal of maintaining a mean blood pressure above 65 mmHg. Lactate levels can also be used to evaluate sepsis-related hypoperfusion. Riverss protocol , also known as early goal-directed therapy, has been proposed for the management of sepsis primarily due to its good results in the trial. This protocol included a central venous pressure higher than 8 cmH2O, maintenance of mean blood pressure above 65 mmHg, and central venous oxygenation saturation higher than 70%. Despite the good results obtained by Rivers and cols, these results could not be reproduced in three subsequent RCTz . If hemodynamic stability is not achieved with fluid resuscitation, vasopressor therapy should be initiated. Norepinephrine is the first-choice vasopressor vasopressin or epinephrine may be added, and dopamine is an alternative to norepinephrine. Dobutamine should be added in patients who show evidence of persistent hypoperfusion despite adequate fluid loading and the use of vasopressor agents.

Figure 2

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How Should This Patient Be Managed

She should receive oxygen by face mask, or if her work of breathing is markedly increased, non-invasive ventilation may be considered. Peripheral intravenous access should be obtained, with consideration of intra-osseous needle insertion if peripheral venous access is not achieved rapidly. Fluid resuscitation should begin with a bolus of 10-20 mL/kg of balanced/buffered crystalloid solution, given over 5 to 20 minutes. Vital signs and peripheral perfusion should be monitored closely to evaluate the response to treatment, including potential fluid overload. Hepatomegaly or crackles on auscultation may suggest fluid overload. The bolus may be repeated depending on patient response, with frequent re-assessment . Clinical deterioration after bolus fluid administration, particularly in the presence of signs of volume overload, suggests the presence of cardiogenic shock . Other useful parameters include urine output, blood gases to assess presence of metabolic acidosis, serum lactate, bedside glucose, serum electrolytes, urea, and creatinine.

The Revolving Door Of Sepsis Care

Pneumonia with Sepsis with Septic shock with acute kidney injury U/D DM HT

As recently as a decade ago, doctors believed that sepsis patients were out of the woods if they could just survive to hospital discharge. But that isnt the case 40 percent of sepsis patients go back into the hospital within just three months of heading home, creating a revolving door that gets costlier and riskier each time, as patients get weaker and weaker with each hospital stay. Sepsis survivors also have an increased risk of dying for months to years after the acute infection is cured.

If sepsis wasnt bad enough, it can lead to another health problem: Post-Intensive Care Syndrome , a chronic health condition that arises from critical illness. Common symptoms include weakness, forgetfulness, anxiety and depression.

Post-Intensive Care Syndrome and frequent hospital readmissions mean that we have dramatically underestimated how much sepsis care costs. On top of the US$5.5 billion we now spend on initial hospitalization for sepsis, we must add untold billions in rehospitalizations, nursing home and professional in-home care, and unpaid care provided by devoted spouses and families at home.

Unfortunately, progress in improving sepsis care has lagged behind improvements in cancer and heart care, as attention has shifted to the treatment of chronic diseases. However, sepsis remains a common cause of death in patients with chronic diseases. One way to help reduce the death toll of these chronic diseases may be to improve our treatment of sepsis.

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