CHAPTER 17: General treatment of pneumonia

Abstract

Even if chemotherapy with antimicrobial agents is administered to patients with pneumonia, the outcome greatly depends on the patient and its surrounding environment. It is crucial to adequately understand the patient’s general condition, and appropriately and promptly improve the factors that have an adverse effect on defence against infection. General treatment means whole-body control to promote a cure for the patient. Pneumonia is a fatal disease. Patients are therefore required to rest and concentrate on the treatment. Measures for resting also include preventive measures against infection, and patients may sometimes be treated in an isolation ward. It is also necessary to avoid cold and high-temperature conditions. However, once the patient’s condition becomes stable, prohibition of bathing should be lifted promptly. Since malnutrition is a major interference with the defence against infection, nutritional management is an important adjunctive therapy. Oral nutritional support is preferable; however, if not achievable, intravenous alimentation or enteral nutrition should be considered at an early stage. In cases of dehydration, water or electrolytes should be replenished promptly. If maintenance fluid therapy is introduced, the necessary amounts of water or electrolytes should be replenished at a constant rate (to maintain a fixed concentration). If electrolyte correction is introduced, infusion fluid is administered over a sufficient period of time at a constant rate (to maintain a fixed concentration) according to the calculated electrolyte level. For severe cases, arterial blood gas analysis (BGA), SpO2 measurement, and ECG, etc. should be performed. For patients requiring ICU management, respiratory or circulatory monitoring should be performed. If the patient develops hypoxemia, O2 administration, intubation, expectoration and artificial respiration should be considered. The necessity for patient isolation and maintenance of hygiene should be considered. Standard preventive measures for healthcare professionals and preventive measures against droplet infection should also be considered. It is indispensable to improve underlying diseases in the treatment of pneumonia. However, an improvement in such conditions is often difficult.