The Pathology of Community-Acquired Pneumonia

A survey of clinicians regarding respiratory physiotherapy intervention for intubated and mechanically ventilated patients with community‐acquired pneumonia. What is current practice in Australian ICUs?

“…Pneumonia occurs from pulmonary infection and inflammation in response to proliferation of pathogenic microorganisms . Exudation of fluid containing inflammatory mediators and blood cells into the alveolar spaces results in consolidation, leading to reduced compliance of the lung tissue .…”

“…Consolidation also impairs gas exchange as a result of ventilation‐perfusion mismatching and shunt, which causes hypoxaemia to occur . Purulent sputum develops as a result of leukocytes, macrophages, and pathogenic microorganisms in the airways and can cause secondary obstruction if secretions are not adequately cleared, resulting in atelectasis of functional lung units, further impairing gas exchange, and worsening hypoxaemia . Antibiotic therapy is the mainstay of treatment for pneumonia …”

Streptococcus pyogenes Pneumonia in Adults: Clinical Presentation and Molecular Characterization of Isolates 2006-2015

“…Currently S . pyogenes is considered a rare cause of community acquired pneumonia, being a clinical entity seen only sporadically after an influenza infection [ 4 – 5 ]. However, the involvement of S .…”

After-hours respiratory physiotherapy for intubated and mechanically ventilated patients with community-acquired pneumonia: An Australian perspective.

“…If no afterhours physiotherapy service is available, intubated patients with acute respiratory illness such as CAP with deteriorating respiratory function may have worse patient outcomes such as prolonged mechanical ventilation time, increased ICU and hospital length of stay, and greater mortality, however to date there are no published data to support this. Due to the pathophysiology of CAP resulting in increased sputum production 4 and reduced lung compliance and alveolar ventilation 3 , sputum retention and atelectasis can occur at any time, not only during day-time hours when an ICU physiotherapist is most likely to be available.…”

“…Severe community acquired pneumonia (CAP) is a common cause for admission to an ICU, for intubation and mechanical ventilation due to respiratory failure and septic shock, and is associated with high levels of morbidity and mortality 1,2 . Lung infection and inflammation in pneumonia result in reduced compliance and alveolar ventilation 3 , and exudation of purulent sputum into the airways 4 , all of which contribute to impaired gas exchange and respiratory failure 3 . Physiotherapists working in ICU commonly treat intubated and mechanically ventilated patients with respiratory illness such as CAP, with the aims of facilitating airway clearance, enhancing alveolar ventilation, improving respiratory mechanics and commencing functional rehabilitation 5,6 .…”