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Hospital-Acquired and Ventilator-Associated Pneumonias (Clinical)

Pneumonia is the infection of the lung parenchyma, resulting from the spread of pathogens and accompanied by the host inflammatory response. This condition is the most common infectious cause of death. Multiple organisms cause pneumonia, including bacteria (of which Streptococcus pneumoniae is the most common), viruses, and fungi. The infection can be acquired while hospitalized (hospital-acquired) or outside the hospital setting (community-acquired). Common symptoms include fever, chills, cough, chest pain, and dyspnea. Chest X-ray usually shows consolidation and/or infiltrates. Diagnosis can be made with clinical presentation and imaging, but in severe cases, microbiological testing (sputum and cultures, molecular testing) and routine blood tests are needed. Empiric treatment with antibiotics is recommended, with regimen depending on the setting, risk factors for multidrug-resistant organisms, and individual comorbidities. Identification of the causative pathogen helps narrow down the antibiotics. Preventive measures include vaccinations (pneumococcal and influenza) and smoking cessation.

Pulmonary Function Tests

Diagnostic modalities such as chest X-rays provide static images of the thoracic cavity, including the lungs and airways. While providing a wealth of anatomical information necessary for the diagnosis of pulmonary disease, chest X-rays do not give much information about the individual's respiratory function. Pulmonary function tests are a group of diagnostic procedures yielding useful, quantifiable information about the rate of the flow of air through the individual's airways, lung capacity, and the efficiency of gas exchange in relation to time. The most commonly utilized tests include spirometry (before and after bronchodilator use), lung volumes, and quantitation of diffusing capacity for carbon monoxide (CO). The tests can be influenced by the individual's effort/fatigue, disease state, or anatomical malformation.

Pleuritis

Pleuritis, also known as pleurisy, is an inflammation of the visceral and parietal layers of the pleural membranes of the lungs. The condition can be primary or secondary and results in sudden, sharp, and intense chest pain on inhalation and exhalation. Etiologies include infection, trauma, cardiac ischemia, and lung cancer. The most common primary infectious cause is a viral infection, and underlying lung infections account for the majority of secondary infectious causes. Management consists of pain control and the treatment of the underlying condition.

Thoracic Surgery

Basic surgical intervention in the thoracic cavity has the primary goal of alleviating any malady that mechanically affects the function of the heart and lungs, which can be secondary to underlying pathologies or, most commonly, trauma. Interventions such as tube thoracostomy and thoracentesis are performed to evacuate fluid, blood, or air that is occupying the thoracic cavity in order to restore thoracic negative pressure. When direct intervention to the heart and mediastinum is required, an emergency thoracotomy is performed. Once the immediate mechanical problems are addressed, more advanced reparative surgery involving heart, lungs, or mediastinal structures can then be performed as necessary.

Pleural Effusion

Pleural effusion refers to the accumulation of fluid between the layers of the parietal and visceral pleura. Common causes of this condition include infection, malignancy, autoimmune disorders, or volume overload. Clinical manifestations include chest pain, cough, and dyspnea. Imaging can confirm the presence of a pleural effusion, and pleural fluid analysis can help in the evaluation of an etiology. Management is dependent on the underlying condition and whether the effusion is causing respiratory distress. Drainage of the effusion may provide symptomatic relief.

Pneumothorax

A pneumothorax is a life-threatening condition in which air collects in the pleural space, causing partial or full collapse of the lung. A pneumothorax can be traumatic or spontaneous. Patients present with a sudden onset of sharp chest pain, dyspnea, and diminished breath sounds on exam. Symptom severity depends on the degree of the collapsed lung. A large or tension pneumothorax can result in cardiopulmonary collapse. A diagnosis is made with imaging, though tension pneumothorax is a clinical diagnosis. Management is based on the size and stability of the patient, and can include needle decompression and chest tube (thoracostomy) placement.

Pneumoconiosis

Pneumoconiosis is an occupational disease that results from the inhalation and deposition of mineral dusts and other inorganic particles in the lung. It can be categorized according to the type of causative particle involved or by the type of response provoked. Coal, silica, asbestos, and talc are the classic fibrogenic types, while beryllium provokes a granulomatous response, and cobalt is associated with giant cell pneumonia. Iron, tin, and barium are considered benign or inert particle types because they do not cause the same type of reactions as the others. After exposure to the fibrogenic types of particles, macrophages and fibroblasts become activated within the pulmonary parenchyma leading to chronic inflammation and fibrosis, which can progress to respiratory failure and death. Occupational history and chest X-rays are the mainstays of diagnosis and staging. Management is mainly symptomatic.

Pneumonia

Pneumonia or pulmonary inflammation is an acute or chronic inflammation of lung tissue. Causes include infection with bacteria, viruses, or fungi. In more rare cases, pneumonia can also be caused through toxic triggers through inhalation of toxic substances, immunological processes, or in the course of radiotherapy.

Pleural Disease: Introduction 03:58 min

Pleural Disease: Introduction 2 quiz questions

Pleural Disease: Introduction 4 Concept Pages
Transudates vs. Exudates 04:59 min

Transudates vs. Exudates 4 quiz questions

Transudates vs. Exudates 4 Concept Pages
Unilateral Pleural Effusions 03:02 min

Unilateral Pleural Effusions 2 quiz questions

Unilateral Pleural Effusions 2 Concept Pages
Pleural Tap 02:38 min

Pleural Tap 2 quiz questions

Pleural Tap 2 Concept Pages
Pleural Biopsy 05:08 min

Pleural Biopsy 3 quiz questions

Pleural Biopsy 2 Concept Pages
Pneumothorax 06:18 min

Pneumothorax 5 quiz questions

Pneumothorax 2 Concept Pages
Tension Pneumothorax 04:00 min

Tension Pneumothorax 6 quiz questions

Tension Pneumothorax 2 Concept Pages
Empyema 06:02 min

Empyema 4 quiz questions

Empyema 2 Concept Pages
Pleural Thickening 01:20 min

Pleural Thickening 1 quiz question

Pleural Thickening 3 Concept Pages
Asbestos Exposure and Pleural Disease 03:13 min

Asbestos Exposure and Pleural Disease 3 quiz questions

Asbestos Exposure and Pleural Disease 1 concept page

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Pleural Disease

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Your Educators of course Pleural Disease

Jeremy Brown, PhD, MRCP(UK), MBBS

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