1 Our goal is to discuss the background, epidemiology, pathogenesis and aspiration pneumonia. We will also go to risk factors, diagnosis and treatment of pneumonia, and how we control our patientBЂ ™ s response to treatment. Finally, I will discuss these objectives patient case. Aspiration is the inhalation of oropharyngeal or gastric contents into the lower respiratory tract. Aspiration is a relatively common event, and it is estimated that approx. 50% of healthy adults aspiration in a dream, but not all people develop pneumonia. There are two factors that must be present to pneumonia results from aspiration. Number 1 represents a compromise inherent protective mechanisms, such as cough, gag reflex, active tsylyarnoy transport and immune response. # 2 bacterial burden aspiration should be high enough to cause infection. True aspiration pneumonia caused by bacteria that are commonly found in the oral cavity, nasopharynx or gastrointestinal tract. These bacteria are usually not pathogenic, however, under certain circumstances they can cause infection. Incidence of aspiration pneumonia in the general population is not clear, because the definition aspiration pneumonia was not always consistent. However, aspiration pneumonia is reported to be the 2nd most common diagnosis among hospitalized patients and Medicare. Most community acquired infections and monomicrobial usually caused by mouth anaerobes. Hospital infections caused by anaerobes also, however, these infections are usually polymicrobial and often caused by aerobic as well. Risk factors for aspiration pneumonia include reduction of consciousness, which threatens the cough and gag reflexes. Neurological deficits that lead to dysphagia. GI disorders such as gastric reflux disease or bowel obstruction. Anesthesia respiratory tract that is to insert the endotracheal tube. Prolonged vomiting, and a large amount of tube feeding, resulting in high residues. The most important feature of aspiration pneumonia is predraspolahayuschym condition for aspiration. We also see, putrid sputum, which may indicate anaerobic infection, and we also see the common symptoms of pneumonia. We diagnose pneumonia presence of infiltrates on chest x-rays in combination with signs of infection without any other reason. We must also obtain samples for culture from the lower respiratory tract. Guidelines for hospital pneumonia suggest that these samples will be obtained broncheoalveolar lavage or protected brush specimen. Once the sample mean he should be sent for culture and sensitivity test. Treatment of aspiration pneumonia include providing oxygen support and correction of the main causes of desire. There are no guidelines to guide us in choosing an empirical antibiotic treatment, but based on what we know about this type of infection, we know that should cover anaerobes. If infection HA, we must also provide coverage for multidrug-resistant pathogens because hospitalized patients are populated by these bacteria for several days. If infection CA, we can use narrow spectrum antibiotics. The way we control our patientBЂ ™ s response to therapy by checking their Tmax, HR, and WBC each of which must fall. We should see improvement in their chest X-ray and oxygenation. His medical history is significant for colon cancer, atrial fibrillation, hip OA, HTN, iron deficiency anemia, and diverticulosis. He is allergic to Lortab, Percocet and carvedilol. It is tobacco and alcohol and denies IVDA. His outpatient medications are furosemide, metoprololtartrate, oksybutynyn, potassium chloride, simvastatin, and Kumadina. His hospital drugs 11/20 were Protonix IV, heparin drip, digoxin IV, metoprolol IV, Cardizem drip and dilaudid ATP. 11/20, his staff was erratic, ranging from 106-158, his blood pressure was also unstable low dimension being 81/42. His respiratory rate was 26 and his oxygen saturation is 90% from 100% FIO2 due to non-rebrizer mask. His blood pH 7. 199, partial pressure of carbon dioxide in the blood were 46 and oxygen 71. His Tmax at 11/20 was 102. 3
AS developed acute respiratory distress syndrome secondary to aspiration pneumonia. He developed septic shock, acute renal failure, and postoperative ileus. The plan is to provide oxygen and IV support, panculture and start empirical antibiotics. His regime was the antibiotic vancomycin, metronidazole, meropenem, fluconazole, levofloxacin, and that de-escalation simply meropenema and levofloxacin. In total he received 15 days of antibiotic therapy. Cultures obtained on 11/20 showed rapid growth of Escherichia coli and Klebsiella pneumonia, each of which was pansensitive. Cultures of blood, urine and stool were negative for bacterial growth. In 7-day treatment with antibiotics he rush, his HR is under control and the WBC were tendencies to normal. In addition, we began to see improvement in chest X-ray. When he was transferred to the intensive care unit, he was requiring high FIO2 and PEEP and 8-day therapy, we can reduce the FIO2, and he is now separate from the fan. My patientBЂ ™ with risk factors for aspiration were his postoperative ileus. He also had signs and symptoms consistent with pneumonia. He had a cough with phlegm, which produced purulent sputum, his oxygenation refused, he had a fever, and his chest X-ray showed abnormalities. He remains in intensive care. He is still on ventilator, but was CPAP trial for 2:00 12/11. He woke up and responds to commands. He was started on tube feeding he had a low tolerance residues. Unfortunately, he developed DVTs in the left upper extremity and right lower extremity, and he also developed a ventilator associated pneumonia and urinary tract infection indicates sputum and urine, which grew Pseudomonas. My treatment patientBЂ ™ s and the corresponding aspiration pneumonia. He was supported with oxygen and antibiotics empirically chosen provided coverage for what eventually grew in the sputum. However, I feel that levofloxacin could be suspended along with other antibiotics and strattera dosage meropenem could be left alone as well as organisms pansensitive. I felt that the identification and correction of obstruction is one of the most important aspects of treatment. His bowel obstruction treated with metoclopramide and erythromycin. Thus, in future, if I never asked what I would recommend for aspiration pneumonia, community acquired, I would recommend levofloxacin to cover drug-resistant pneumococcus metronidazole for anaerobic coverage. For hospital acquired, I would recommend metronidazole with meropenem for Pseudomonas coverage and double coverage aztreonam Pseudomonas. .
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