TREATMENT OF PNEUMONIA

The pneumonia patient may be in one of three states :

• Stable ( in other words, eating well and active despite anasty cough. These patients can often be treated at home ).
• Unstable ( poor appetite, inactive, in need of hospitalization).
• Critical ( unable to get enough oxygen into their systems.These patients require oxygen therapy and possibly 24 hour care ).
• The goal is to get the patient stable enough for hometreatment as several weeks are needed to fully clear pneumonia. When thepatient is eating well, he or she may be discharged with oral antibiotics,regimen of physical therapy, and a schedule for re-check radiographs ( usuallyweekly ).

The hospitalized patient will have the following needs :

Intravenous fluid therapy Coughing may be annoying but it is therapeutic and, when it comes to pneumonia,we want to encourage it, not suppress it. Coughing brings up the pus, mucus,and inflammatory cell products, that make our patient sick. If the secretionsof the lung are allowed to dry up, the patient will never be able to cough themup. For this reason, IV fluids must be maintained to keep our patient hydratedand keep the respiratory secretions wet.

Antibiotic therapy
Antibiotics are given to kill the bacteria but which antibioticsshould we choose. We need something that will penetrate into the pus and mucus( which many antibiotics cannot do ). Often a “four quadrant” approach is used: which covers bacteria classified as Gram negative and Gram positive as wellas those classified as aerobic and anaerobic). This typically involves 2antibiotics used in combination to synergize one another.

Alternatively, the lungs may be cultured via a procedurecalled a “tracheal wash.” This process involves light sedation which thepatient must be stable enough to withstand. Sample fluid from deep in the lungcan be retrieved for culture. Culture identifies the organism and provides alist of antibiotics which can kill it. If the patient is sick enough forhospitalization, antibiotics are typically given as injections so as tomaximize absorption into the body.

Nebulization This technique involves a special piece of equipment called a “nebulizer,”which creates a mist of fine saline droplets. The droplet size determines howfar into the respiratory tract the moisture can be inhaled. Vaporizer dropletsare typically halted in the nasal passages and throat while nebulized dropletscan travel all the way into the lung. Nebulized saline may carry antibioticswith it thus providing an additional source of moisture and antibiotic for thesick lung.

Physical Therapy A technique called “coupage” is helpful at mobilizing respiratory secretions.The therapist’s hand is cupped and gently but rapidly taps the patient’s chestwall repeatedly. This loosens some of the deeper secretions and helps them moveinto airways. Material in the airway generates coughing which removes thesematerials from the body. Coupage should be performed at least four times dailyand should be continued at home as long as the patient has a cough.

Light exercise is also helpful in mobilizing the respiratorysecretions. The patient should not be over-exerted as he/she does not havenormal lung capacity but one can use one’s judgement as to what level ofexercise is tolerated by the patient.

Oxygen Therapy
In most cases, oxygen therapy is not necessary but when a pneumoniapatient simply cannot move enough air there is no substitute for oxygen. Roomair is 20% oxygen. An oxygen cage typically is set to deliver 40% oxygen (higher percentages over long term are actually toxic to lung cells ), andspecial oxygen-delivery hoods are also popular. A patient who requires thislevel of support is extremely sick.

Once the patient has a good appetite, he or she may bedischarged for home care. The following tips are recommended as long as thepatient is coughing :

• Do not allow prolonged exposure to extreme cold or wetweather. Keep your pet primarily indoors.
• Consider use of a vaporizer for 15 - 20 minute intervals acouple of times daily. If you do not have a vaporizer, leave the pet in thebathroom with the shower on to create a misty vapor.
• Perform coupage at least 4 times daily and allow lightexercise to promote the cough.
• Do not try to suppress the cough with over-the-counter coughsuppressants. We want the infected material in the chest to be coughed up.
• Use the antibiotics as directed. Expect several weeks to berequired.
• Know what you should return for re-check radiographs.

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