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There are several criteria for the severity of pneumonia, based on this, one or another treatment is prescribed. Accordingly, mild pneumonia can be treated on an outpatient basis, that is, but when moderate and severe pneumonia is diagnosed, it is better to undergo treatment in a hospital.
The degree of severity is determined on various scales in order to understand which treatment method is most effective for the patient. After all, the same pathogen can lead to different conditions in people. In this article we will talk about existing criteria and scales.
Standard and occupying long time Laboratory tests, as a rule, have no effect on pneumonia. Therefore, there is no need for this type of diagnosis, especially when it comes to a hospital stay. For acceptance the right decision, as a rule, use scales that define criteria severe course pneumonia. Both in children and adults.
Very rarely in the prehospital period it is possible to determine the amount of nitrogen in the urine. Based on this, the severity of pneumonia is assessed using the CURB-65 scale (Kurb-65):
For each of the indicators that are in the table, you are charged 1 point. They are summed up, and depending on the final result, treatment tactics are determined in each specific case.
In the absence of these signs, the risk of mortality is 1.3%, which is an indication for the possibility of therapy at home. With a result of 1-3 points, the risk increases to 9%, which is a reason to adjust the status to.
At maximum risk fatal outcome, constituting more than 31% and an amount of 4-5 points, emergency hospitalization is required.
If you suspect negative consequences illness or the impossibility of receiving correct treatment at home, patients are also indicated for therapy in a hospital setting.
You can also determine the level of severity using a scale PORT (PneumoniaSeverityIndex) with index calculation PSI (Pneumonia Outcomes Research Team). It was created in 1997 to diagnose 20 clinical and laboratory research, where the prognosis of the disease depends on the amount of points scored. Accordingly, the higher the summed score, the worse the outcome of the disease.
The disadvantage of this scale is large number points, long waiting times for laboratory tests and additional research which slows down. The grid is designed to determine the level of mortality risk, not the location of treatment. Low level mortality, based on this scale, does not mean at all that complications of pneumonia will also be minimized.
| Determination of risk class | |
| At the time of examination | |
| Age up to 50 years | 1 point |
| Disorganization of consciousness | 1 point |
| Heart rate ≥ 125 beats per 60 sec. | 1 point |
| Breathing frequency ˃ 30 per 60 seconds. | 1 point |
| The upper level of blood pressure is ˂ 90 mm Hg. Art. | 1 point |
| Body temperature is more than 35˚С or ≥ 40˚С | 1 point |
| Existing diseases | |
| Malignant tumor | 1 point |
| pumping function hearts"> | 1 point |
| Nephrosis | 1 point |
| Cerebrovascular diseases | 1 point |
| Hepatosis | 1 point |
If even one point is identified, you should go to Table 2. Provided that all the answers are negative, the patient can be assigned to 1 threat group.
| Threat level in points | |
| Patient data | Score (points) |
| Men | + number of years |
| Women | + number of years – 10 |
| Staying in a nursing home | 10 |
| Hepatosis | 20 |
| Malignant tumor | 30 |
| Cerebrovascular disease | 10 |
| Nephrosis | 10 |
| Impaired pumping function of the heart | 10 |
| Impaired consciousness | 20 |
| Number of heart contractions ≥125 beats/min | 20 |
| Breathing frequency ˃ 30 per minute. | 20 |
| Systolic blood pressure ˂ 90 mm Hg. | 15 |
| Temperature ˂ 35˚С or ≥ 40˚С | 10 |
| arterial blood? 7.35">arterial blood pH ˂ 7.35 | 30 |
| Amount of sodium ˂130mmol/l | 20 |
| Urea nitrogen level ≥9mmol/L | 20 |
| Glucose amount ≥14mmol/l | 10 |
| Hematocrit ˂ 30% | 10 |
| History of pleural effusion | 10 |
| PaO2-˂60 mm Hg. | 10 |
The severity of pneumonia and risk classes are assessed based on the sum of the points scored. For example, if this indicator is ˂51, then the class is considered first if ˂ 70, then the class is defined as second, and the degree is considered low and is conducive to treatment in outpatient setting. If the amount is from 71-90 points, class is considered third, the degree is still low, and treatment is carried out at home or for a short time in a hospital setting.
With indicators from 91-130 points in an adult or child, the degree is moderate and requires hospitalization, class in this case fourth. And finally, dialed ˃130 points, talk about high degree risk requiring immediate transfer to the intensive care unit.
The newest method for determining the degree of risk is the SMARTCOP or SMRTCO scale (simplified version).
The difference in the names of these scales is due to the lack of SMRTCO carrying out tests to determine blood pH and albuminemia.
When assessing 0-1 points– the risk is low, hospitalization in this case is not necessary. When dialed 2 points– the patient should receive treatment in a hospital setting, the risk is average. Indicator 3, 4 or more points means necessity urgent hospitalization in the intensive care unit.
The SMARTCOP score is a set of criteria to determine the class of patients who require ICU treatment.
| Definition | Score in points | |
| S | Systolic blood pressure<90 мм рт. ст | 2 |
| M | Multilobar infiltration on chest x-ray | 1 |
| A | Blood albumin level<3,5 г/дл* | 1 |
| R | Периодичность дыхания. ≤50 лет – ≥25/мин, >50 лет – ≥30/мин !} | 1 |
| T | Heart rate ≥125 beats/min | 1 |
| C | Impaired consciousness | 1 |
| O | PaO2 !}<70 мм рт. ст. при возрасте ≤50 лет,<60 мм рт. ст. при возрасте >50 years old; SpO2<94% при возрасте≤50 лет; <90% при возрасте >50 years | 2 |
| P | Arterial blood pH<7,35* | 2 |
| ˮ * ˮ – not included in the SMRTCO scale | ||
The results are deciphered as follows:
Pneumonia can be classified according to three severity criteria: mild, moderate and severe. The characteristics can be carried out using the table:
| Signs of severity | Lightweight | Average | Heavy |
| Blood pressure | Normal | Slightly reduced | Severe hypotension |
| Body temperature | Up to 38˚С | 38-39˚С | 39˚С and above |
| Heart rate per minute | Less than 90 strokes | 90-100 beats | Tachycardia (100 beats and above) |
| Respiratory rate per minute | Up to 25 | 25-30 | Over 35 |
| Hypoxemia | absent | average | pronounced |
| Extent of lesions | Not significant | moderate | expressed |
| Intoxication | No | moderate | acute |
| Complications | Not identified | Pleurisy with slight effusion |
The main criterion for prescribing treatment for the disease is to assess the stage of pneumonia, taking into account its severity. It is impossible to independently predict the course of the inflammatory process and destroy infectious pathogens.
When diagnosing a disease based on an examination, doctors take into account many indicators according to the working classification of the Ministry of Health:
| Pneumonia criteria | Characteristic |
| Forms of infection | In-hospital. Out-of-hospital. In patients with immunodeficiency. |
| Etiology by type of pathogen | Streptococci (more than 30% of infected people). Pneumococci (from 15%). Mycoplasmas (from 12%). Chlamydia (13%). Haemophilus influenzae (up to 5%). Legionella (from 5%). Enterobacteriaceae (from 5%). Staphylococci (up to 4%). CMV viruses (from 3%). Fungi (up to 4%). Others (from 3%). |
| Epidemiological conditions | Aspiration. Alcoholism, drug addiction. Cystic fibrosis. Bronchiectasis. Bronchial obstruction. Oncology. Immunodeficiency. After operations, injuries. Diseases of the liver, blood. The influence of drugs. Persons over 65. Children. |
clinical and morphological. |
Focal. Double-sided. Croupous (lobar). |
| Extent and localization of foci of inflammation | Segmental pneumonia. Total. |
| According to the severity of the disease | Mild degree. With a complication. |
| By type | Atypical. Typical. |
The overall picture of pneumonia is determined according to the combination of all these factors. The main criteria for selecting antibiotics for treatment are the stage of development and severity of pneumonia. Self-medication can worsen the patient's condition, even leading to death.
The criteria for the development of the disease are completely dependent on many factors:
The severity of the inflammatory process in the lungs is especially influenced by the type of pathogen.
The onset of mild acute pneumonia is characterized by the following symptoms:
A person's condition with lung disease is assessed as moderate or severe. Stage duration: from 2 hours to 2–3 days.
Moderate pneumonia is diagnosed by the following signs of the disease: 
The patient's condition at the second stage of the disease is considered stable and serious.
Due to increasing intoxication, there is a threat of general hypoxia of body cells, and the risk of damage to the liver, kidneys, and brain tissue also increases.
Pneumonia in the “gray hepatization” stage is distinguished according to the following characteristics:
In cases of lack of treatment, negative symptoms increase sharply at this stage of the disease:
With correct treatment, stage 4 is resolving: a person’s condition improves significantly in 10–11 days. Severe pneumonia is treated exclusively in hospitals.
In the absence of drug therapy with antimicrobial drugs, symptoms of extremely severe pneumonia appear, and negative complications of the disease develop:
There may be damage to the cardiovascular, nervous, urinary, endocrine and other body systems.
The severity and stage of pneumonia are easily determined by radiography: in the images during the height of pneumonia, darkening of different sizes and extent can be seen. During the recovery process, a decrease in darkening is revealed, as well as the disappearance of foci of infiltration.
Depending on all the combined factors that determine the stage of development, the severity of pneumonia can be aggressive or last a very long time.
Characterized by pronounced symptoms. Usually it is very difficult at any stage. The main causes are viral and bacterial infection, complicated by chronic sluggish diseases of the human body, as well as immunodeficiency due to exhaustion.
Symptoms in all stages are not as negatively expressed as in the acute onset of the disease, so treatment does not begin in a timely manner. Which leads to a long course of the disease.
In the absence of high fever, severe cough, or chest pain, a person identifies a cold himself and begins to treat himself with available home remedies. Meanwhile, the inflammatory process spreads widely throughout the lungs, causing severe intoxication of the body. As a result, damage occurs to cardiac tissue, nerve cells, and hematopoietic organs. The prognosis is favorable if the disease is recognized in time.
It occurs as a result of a complication of a mild disease due to an incorrect diagnosis, incorrect treatment of diseases or its absence. The danger of pneumonia lies in the constant resumption of acute progression of inflammatory processes in the lungs at the slightest cold. In addition, with chronic pneumonia, severe complications occur much more often.
Often there are no obvious symptoms of the disease: cough, sputum, chest pain. High temperature and severe weakness at the initial stage of the disease are considered signs of influenza; as a result, the body becomes intoxicated, and microorganisms in the lungs cause irreversible obstructive changes. Severe atypical pneumonia should be treated under medical supervision.
To avoid dangerous complications of any type and stage of pneumonia, you must immediately seek medical help at a clinic.
Depending on the symptomatology of which stage of pneumonia caused you to see a doctor, the medical background of the treatment is determined and the intensity of the course is prescribed. The disease requires complex therapy; the specifics of the intervention vary according to the clinical picture at each stage.
Depending on the intensity of the lesion, the following categories of inflammation are distinguished:
The pathology can be aggravated by the following conditions:
Severe inflammation is often diagnosed in people from vulnerable sections of the population, patients living in unfavorable conditions.
The first stage of pneumonia is also called the flushing stage; in adults, this stage can last up to three days. A common reason for delayed diagnosis of pathology is the similarity of this early process with respiratory diseases. The patient may notice a dry cough and shortness of breath, signs of fever, pain in the sternum during inhalation and exhalation.
With the rapid development of a severe form of the disease, confusion may occur and hallucinations may occur. Movements of the chest are often asymmetrical, as swelling occurs in the affected lobe. Cyanosis of the lips and hyperemia of the cheeks are possible.
The red liver stage is accompanied by a rapid deterioration in health; usually the diagnosis is formulated at this stage. This stage of inflammation development can last up to three days, during which time the lung tissue thickens, turns red, and the alveoli are filled with plasma. Breathing causes severe pain, and the body temperature remains high. Severe fever appears, intoxication occurs, and reddish sputum is released.
The stage is characterized by a stable and serious condition of the patient. The patient suffers from hallucinations, panic attacks, and is afraid of death. The cause of these phenomena is oxygen hypoxia. During listening, wheezing clearly stands out.
Lobar pneumonia at the gray hepatic stage does not require constant medical supervision, unlike the previous stage. With lobar pneumonia, the patient is still in serious condition, but intoxication gradually recedes, coughing helps clear the bronchi from mucus.
Within 4-8 days, the lungs change color to gray and brown, and active breakdown of red blood cells occurs in the alveoli. Acute painful sensations when breathing turn into dull pain, body temperature returns to normal. Pus may come out along with sputum.
This stage is also called the resolution stage, since during it the patient gradually recovers. Treatment continues, the patient complies with the prescribed regimen. In 10-12 days, the structure of the lungs returns to a healthy phase, the sputum thins out and resolves. Body temperature is kept at a normal level. The cough still persists, but the sputum is released painlessly, it is clean, breathing and heart rate are normalized.
The stages of pneumonia in children occur rapidly; they are characterized by more pronounced symptoms at stages 2 and 3.
Treatment is prescribed depending on the identified form of pathology:
Atypical pneumonia, which has smoothed out signs and a mild change of stages, is placed in a separate category. At the same time, patients do not produce mucus or sputum, and there is no cough. The disease manifests itself in the form of severe intoxication, severe malaise against the background of a sharp increase in temperature.
If you suspect any stage or form of pneumonia, you should immediately consult a doctor: if qualified medical care is provided at the first sign, the chances of recovery without complications associated with the disease increase significantly.
The stages of pneumonia play a decisive role in the management of the patient. The course of the disease, depending on the processes occurring in the lung tissue, has a certain stage and depends on the reactivity of the body, the treatment performed and the presence of concomitant pathology. What stages is it divided into, and what are the severity levels of pneumonia? You can find out more about this in the proposed article.
Pneumonia is one of the most common acute infectious and inflammatory diseases. In our country, about 700 thousand cases of illness are registered annually. The typical course of the disease with the appearance of classic symptoms is common; atypical forms are much less common. The main symptom complexes of the pathology are: fever, intoxication and damage to the respiratory part of the lungs.
The mortality rate from this pathology is not very high, this is due to the success of diagnostic and therapeutic measures. Fatal outcome occurs in weakened patients who are in critical condition and have immunodeficiency.
Depending on the circumstances of its occurrence, the disease is divided into:
Depending on which part of the inflammation occurs, it can be: upper, middle, lower lobe.
If pneumonia occurs in a healthy person, then it is considered primary; if it is a complication of another pathological process, it is considered secondary.
Abortion disease is also isolated. In this case, regression of symptoms occurs very quickly; as a rule, the disease ends at the initial stage. This is due to timely treatment, precise choice of antimicrobial drug, and a good immune system.
If the course is prolonged, the recovery period is delayed by 4 or more weeks. At the same time, mild residual effects persist (cough, asthenia, low-grade fever). On a radiograph, the infiltrative focus is not identified, but an enhanced pulmonary pattern remains.
When pneumonia occurs, the stages of its progression have a certain pattern.
The duration and severity of each period depend on many factors, the main of which are:Regardless of the severity and nature of the disease, the pathological process goes through all three stages of development of the inflammatory process.
The disease begins acutely with an increase in body temperature to 39 - 40°C against the background of complete health or another pathological process, most often an acute respiratory infection.
The initial stage is characterized by severe symptoms of intoxication and is accompanied by such clinical manifestations as:
The patient's condition is serious, there is redness of the cheeks and cyanosis of the nasolabial triangle. Breathing is frequent, cough is painful. In the area of the wings of the nose, herpetic rashes may occur from the damaged lung.
At this stage, the patient's condition remains serious.
The main clinical manifestations during the peak period are characterized by the following symptoms:
At this stage, other organs (liver, meninges, kidneys) may be involved in the pathological process. When pleurisy develops in the area of inflammation of the lung tissue or when the bronchus is blocked by viscous mucus, respiratory sounds are not heard in this place.
During this stage, the patient's condition gradually improves. Shortness of breath goes away, cough occurs less frequently, sputum comes out well in small quantities. Body temperature decreases and your health becomes better, your appetite appears.
The disease is characterized by its severity; death may occur from acute cardiac or pulmonary failure.
Complications may develop such as:
The most severe form of pneumonia is lobar pneumonia, in which an entire lobe of the lung is affected. With focal inflammation, the clinical picture will depend on the amount of tissue damage.
Symptoms of the disease are those human sensations that arise as a result of the inflammatory process in the lungs.
In this case, the structure of the cells is disrupted, various morphological changes occur in them, depending on which the following stages of structural change are distinguished:During the high tide stage, the blood vessels at the site of injury expand, they become permeable, which activates the mechanism of fluid leakage into the area of injury. Inflammatory exudate permeates the walls of the alveoli and surrounding tissues. Swelling occurs and the alveoli lose their functionality.
When compaction occurs, further impregnation of the tissues with inflammatory fluid and formed elements occurs. As a result, the lung at the site of injury becomes dense, red, resembling the structure of the liver. Hence the name of the stage - hepatization or hepatization.
During the resolution stage, swelling gradually subsides. Under the action of enzymes, fibrin areas are reabsorbed. The lung tissue still remains edematous for some time, but the airiness of the alveoli is gradually restored.
The severity of pneumonia in adults determines management tactics, the choice of treatment at home or in a hospital, as well as the prognosis for life and health.
During the course of the disease, the following degrees of severity are distinguished:
In extremely severe cases, the patient's condition is critical. Breathing is supported by mechanical ventilation. The course of such pneumonia is associated with a large number of complications and a high probability of death.
Pneumonia is a severe inflammatory process that can lead to serious consequences due to the development of complications.
Knowledge of the stages of the process and criteria for severity helps the doctor to navigate the choice of antibacterial agent and prescribe drug therapy, determine the prognosis of the disease and life.
– acute lung injury of an infectious-inflammatory nature, which involves all structural elements of the lung tissue, mainly the alveoli and interstitial tissue of the lungs. The clinical picture of pneumonia is characterized by fever, weakness, sweating, chest pain, shortness of breath, cough with sputum (mucous, purulent, “rusty”). Pneumonia is diagnosed based on auscultation patterns and chest x-ray data. In the acute period, treatment includes antibiotic therapy, detoxification therapy, immunostimulation; taking mucolytics, expectorants, antihistamines; after the cessation of fever - physiotherapy, exercise therapy.
Pneumonia is an inflammation of the lower respiratory tract of various etiologies, occurring with intra-alveolar exudation and accompanied by characteristic clinical and radiological signs. Acute pneumonia occurs in 10-14 people out of 1000, in the age group over 50 years - in 17 people out of 1000. The relevance of the problem of the incidence of acute pneumonia remains despite the introduction of new antimicrobial drugs, as well as a high percentage of complications and mortality (up to 9%). ) from pneumonia.
Among the causes of mortality among the population, pneumonia ranks 4th after heart and vascular diseases, malignant neoplasms, injuries and poisoning. Pneumonia can develop in weakened patients, joining the course of heart failure, cancer, cerebrovascular accidents, and complicating the outcome of the latter. In patients with AIDS, pneumonia is the main immediate cause of death.
Among the etiofactors that cause pneumonia, bacterial infection comes first. The most common causes of pneumonia are:
Pneumonia can also develop due to exposure to non-infectious factors: chest injuries, ionizing radiation, toxic substances, allergic agents.
The risk group for the development of pneumonia includes patients with congestive heart failure, chronic bronchitis, chronic nasopharyngeal infection, congenital malformations of the lungs, with severe immunodeficiency conditions, weakened and exhausted patients, patients who have been on bed rest for a long time, as well as elderly and senile people .
People who smoke and drink alcohol are especially susceptible to developing pneumonia. Nicotine and alcohol vapors damage the bronchial mucosa and inhibit the protective factors of the bronchopulmonary system, creating a favorable environment for the introduction and proliferation of infection.
Infectious pathogens of pneumonia penetrate the lungs through bronchogenic, hematogenous or lymphogenous routes. When there is a decrease in the protective bronchopulmonary barrier in the alveoli, infectious inflammation develops, which spreads through the permeable interalveolar septa to other parts of the lung tissue. In the alveoli, exudate forms, preventing oxygen gas exchange between the lung tissue and blood vessels. Oxygen and respiratory failure develop, and with complicated pneumonia, heart failure.
There are 4 stages in the development of pneumonia:
Characterized by an acute onset with fever above 39°C, chills, chest pain, shortness of breath, and weakness. The cough is disturbing: at first it is dry, unproductive, then, on the 3-4th day, with “rusty” sputum. Body temperature is constantly high. With lobar pneumonia, fever, cough and sputum production last up to 10 days.
In severe cases of lobar pneumonia, hyperemia of the skin and cyanosis of the nasolabial triangle are determined. Herpetic rashes are visible on the lips, cheeks, chin, and wings of the nose. The patient's condition is serious. Breathing is shallow, rapid, with flaring of the wings of the nose. On auscultation, crepitus and moist fine bubbling rales are heard. The pulse is frequent, often arrhythmic, blood pressure is reduced, heart sounds are muffled.
It is characterized by a gradual, subtle onset, most often after acute respiratory viral infection or acute tracheobronchitis. The body temperature is febrile (38-38.5°C) with daily fluctuations, the cough is accompanied by the discharge of mucopurulent sputum, sweating, weakness are noted, when breathing - pain in the chest when inhaling and when coughing, acrocyanosis. With focal confluent pneumonia, the patient's condition worsens: severe shortness of breath and cyanosis appear. On auscultation, hard breathing is heard, exhalation is prolonged, dry small- and medium-bubble rales, crepitus over the source of inflammation.
Features of the course of pneumonia are determined by the severity, properties of the pathogen and the presence of complications. The course of pneumonia is considered complicated, accompanied by the development in the bronchopulmonary system and other organs of inflammatory and reactive processes caused directly by pneumonia. The course and outcome of pneumonia largely depend on the presence of complications. Complications of pneumonia can be pulmonary or extrapulmonary.
Pulmonary complications of pneumonia can include:
Among the extrapulmonary complications of pneumonia, the following often develop:
When diagnosing pneumonia, several problems are solved at once: differential diagnosis of inflammation with other pulmonary processes, clarification of the etiology and severity (complications) of pneumonia. Pneumonia in a patient should be suspected based on symptomatic signs: rapid development of fever and intoxication, cough.
Patients with pneumonia are usually hospitalized in the general medical department or the pulmonology department. During the period of fever and intoxication, bed rest, plenty of warm drinks, and high-calorie, vitamin-rich food are prescribed. For severe symptoms of respiratory failure, patients with pneumonia are prescribed oxygen inhalation. Main directions of therapy:
Treatment of pneumonia is carried out until the patient’s complete recovery, which is determined by the normalization of condition and well-being, physical, radiological and laboratory parameters. With frequent repeated pneumonia of the same localization, the issue of surgical intervention is decided.
In pneumonia, the prognosis is determined by a number of factors: the virulence of the pathogen, the age of the patient, underlying diseases, immune reactivity, and the adequacy of treatment. Complicated variants of the course of pneumonia, immunodeficiency states, and resistance of pathogens to antibiotic therapy are unfavorable in terms of prognosis. Pneumonia in children under 1 year of age caused by staphylococcus, Pseudomonas aeruginosa, and Klebsiella is especially dangerous: the mortality rate for them ranges from 10 to 30%.
With timely and adequate treatment measures, pneumonia ends in recovery. Depending on the types of changes in the lung tissue, the following outcomes of pneumonia can be observed:
Measures to prevent the development of pneumonia include hardening the body, maintaining immunity, eliminating the factor of hypothermia, sanitizing chronic infectious foci of the nasopharynx, combating dust, stopping smoking and alcohol abuse. In weakened bedridden patients, in order to prevent pneumonia, it is advisable to carry out breathing and therapeutic exercises, massage, and prescribe antiplatelet agents (pentoxifylline, heparin).
