Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • dyspnoea
  • productive cough
  • fever

Other diagnostic factors

  • chest pain
  • asymmetrical expansion of the chest
  • diminished resonance
  • egophony
  • whisper pectoriloquy
  • crackles or rhonchi
  • tachycardia
  • malaise/anorexia

Risk factors

  • poor infection control/hand hygiene
  • head of bed at <30° angle
  • intubation and mechanical ventilation; endotracheal cuff pressure <20 cm H2O
  • H2 antagonist and antacid use
  • poor oral hygiene
  • no interruption in sedation

Diagnostic investigations

1st investigations to order

  • CXR
  • WBC count with differential
  • pulse oximetry
  • culture of lower respiratory tract sample
Full details

Investigations to consider

  • ABG
  • diagnostic thoracentesis
  • CT chest
  • CRP
  • procalcitonin
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Forest W. Arnold

Associate Professor of Medicine

Division of Infectious Diseases

Department of Medicine

School of Medicine

University of Louisville

Louisville

KY

Disclosures

FWA declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Professor (Clinical)

Department of Medicine

University of Utah

Director

Pulmonary and Critical Care Research

IHC Urban South

Utah Valley Pulmonary Clinic

UT

Disclosures

KS declares that he has no competing interests.

Director of Research

Associate Professor

Department of Anesthesiology and Perioperative Medicine

Neuroscience and Anesthesia Intensive Care Unit

University of Louisville

Louisville

KY

Disclosures

OA declares that he has no competing interests.

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