Pneumonia is an infectious and inflammatory lung disease that can affect any age and social group of people. There are a number of different criteria that allow you to assess whether a patient with pneumonia needs hospitalization in a specialized department. Treatment of pneumonia in the hospital is carried out for patients with a severe course of the disease, with the threat of complications or in the presence of serious comorbidities.
Length of hospital stay
Patients with moderate or severe pneumonia who have a high risk of death or complications are subject to hospitalization in a therapeutic or pulmonary hospital.
The length of stay of patients in the department depends on:
- the duration of the prescribed antibiotic therapy (with typical pneumonia, antibiotics are prescribed for 7-10 days, and with inflammation caused by atypical or resistant flora, the course can reach 21-25 days);
- dynamics of the clinical picture (with an improvement in well-being, outpatient treatment is possible);
- changes in the indicators of laboratory and instrumental studies (decrease in leukocytosis, decrease in the sedimentation rate of leukocytes, disappearance of infiltration of the pulmonary parenchyma on the plain radiograph of the lungs);
- the age of the patient (for newborns, young children and the elderly, the period of treatment in a hospital is increased).
Average length of hospital stay depending on pneumonia etiology:
|Etiological factor of pneumonia(pathogen microorganism)||Average duration of treatment in the department|
|Streptococcal infection||7-10 days|
|Viral infection (uncomplicated)||7-12 days|
|Pneumococcal infection||10-15 days|
|Gram-negative flora||10-20 days|
|Atypical pathogens (chlamydia, Pseudomonas aeruginosa, mycoplasma)||15-25 days|
|Mixed infection (mixed microflora)||20-25 days|
With bilateral or unilateral total lung injury, treatment should last at least 21 days.
There is also a group of patients with mild pneumonia who are admitted to the department for social reasons (unfavorable living conditions, no permanent place of residence). Therapy for such patients is carried out according to outpatient treatment schemes (taking oral medications), and their stay in the hospital does not exceed 10-12 days.
In especially severe cases, when the patient needs special care or mechanical ventilation, treatment is carried out in the intensive care unit.
Features of the treatment of pneumonia in the hospital
The main link in the treatment of pneumonia is etiological drug therapy (antibiotics), which allows you to eliminate the cause of the disease. In patients admitted to the hospital due to severe pneumonia, therapy should be started immediately with the appointment of a parenteral method of administration (intravenous or intramuscularly) of antibacterial drugs. Oral antibiotics have a less pronounced effect, therefore, they are most often used only for outpatient treatment.
For effective eradication of the pathogen from the body, you need to select a group of antibiotics that can affect these microorganisms. To establish the type of infection, a microbiological examination of sputum is carried out and the sensitivity of the flora to antibacterial agents is determined. To do this, sowing is carried out on special nutrient media, on which bacteria subsequently grow.
It is necessary to wait 5-7 days for the sowing results, therefore, at the initial stages of treatment, drugs are selected empirically (most often antibiotics of a wide spectrum of action are prescribed). Evaluate the effect of the prescribed antimicrobial treatment in an uncomplicated course after 48 hours, and in a complicated one – after 72 hours. If during this period there is no dynamics towards recovery, the treatment is replaced with another group of antibacterial drugs.
Criteria that indicate the effectiveness of antibiotics:
- decrease in body temperature;
- reduction of shortness of breath;
- improvement of the general condition;
- decrease in blood neutrophilia;
- positive X-ray dynamics.
After receiving the microbiological analysis data, the treatment regimen is corrected in accordance with the identified microflora and its sensitivity to drugs.
In addition to etiological therapy, the patient also needs an appointment:
- infusion therapy (intravenous drip of saline solutions in combination with forced diuresis allow to ensure adequate detoxification of the body);
- analgesic drugs (especially with croupous pneumonia, when the pleura is involved in the pathological process and a sharp pain syndrome occurs);
- antipyretics (medicines that lower body temperature);
- anti-inflammatory therapy;
- mucolytic agents (improve the rheological properties of sputum and mucus, help cleanse the respiratory tract);
- drugs from the group of antihistamines (reduce the release of inflammatory mediators and prevent body sensitization).
In addition to the main drug therapy, patients are prescribed without fail:
- therapeutic diet (diet No. 11 according to Pevzner);
- inhalation in case of respiratory failure (to improve blood oxygenation and prevent hypoxia);
- physiotherapy procedures (inhalation of medicinal substances, therapeutic massages).
Treatment of pneumonia in a hospital in children corresponds to the basic principles of therapy in adults. However, it should be borne in mind that respiratory failure in them develops faster and is less amenable to correction, therefore, even with a mild course of pneumonia, it is necessary to control the gas composition of the blood (oxygen saturation). You also need to pay attention to the fact that some antibacterial drugs that are widely used for adults are contraindicated in children.
Particular attention is paid to pneumonia, which has arisen in the elderly, since their disease progresses very rapidly. When choosing therapy for elderly people, the reduced reactivity and resistance of the body, as well as the severity of concomitant diseases, are taken into account.
Treatment of pregnant women at a later date (after 22 weeks) is carried out only in a specialized obstetric department. The choice of drugs that can be used during pregnancy should be carried out with particular care in order to avoid intrauterine fetal pathology.
Treatment of pneumonia in a specialized hospital allows you to provide the patient with the correct therapeutic and protective regimen. The advantage of treatment in a medical institution is the possibility of parenteral treatment and constant monitoring of the patient’s condition. Treatment of children and people over 70 years old should be stationary even with a relatively mild and uncomplicated course of pneumonia, since patients in these groups have a high risk of developing complications and urgent life-threatening conditions.