Last reviewed: 25 Aug 2021
Last updated: 06 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • low oxygen saturation
  • acute respiratory failure

Other diagnostic factors

  • critically ill patient
  • dyspnoea
  • increased respiratory rate
  • pulmonary crepitations
  • low lung compliance
  • fever, cough, pleuritic chest pain
  • frothy sputum

Risk factors

  • sepsis
  • aspiration
  • pneumonia
  • severe trauma
  • blood transfusions
  • lung transplantation
  • pancreatitis
  • history of alcohol misuse
  • burns and smoke inhalation
  • drowning
  • e-cigarette and vaping product use
  • drug overdose
  • cigarette smoking

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • arterial blood gases
  • sputum culture
  • blood culture
  • urine culture
  • amylase and lipase

Investigations to consider

  • brain natriuretic peptide (BNP)
  • echocardiography
  • pulmonary artery catheterisation
  • bronchoalveolar lavage or endotracheal aspirate
  • CT scan of the thorax
  • viral testing
  • open lung biopsy

Treatment algorithm

Contributors

Authors

Lorraine Ware, MD
Lorraine Ware

Professor of Medicine and Pathology, Microbiology and Immunology

Director

Vanderbilt Medical Scholars Program

Division of Allergy, Pulmonary and Critical Care Medicine

Department of Medicine

Vanderbilt University School of Medicine

Nashville

TN

Disclosures

LW has received research contract support from CSL Behring, Boehringer Ingelheim and Genentech. She has received consulting fees and/or scientific advisory board fees from CSL Behring, Merck, Foresee, Citius, and Boehringer Ingelheim.

Acknowledgements

Dr Lorraine Ware would like to gratefully acknowledge Dr Richard Fremont, a previous contributor to this topic.

Disclosures

RF declares that he has no competing interests.

Peer reviewers

Michael A. Matthay, MD

Director of Medicine Critical Care Fellowship

Department of Anesthesia and Perioperative Care

University of California San Francisco

CA

Disclosures

MAM declares that he has no competing interests.

Timothy Evans, MBBS

Professor of Intensive Care Medicine

Royal Brompton Hospital

London

UK

Disclosures

TE declares that he has no competing interests.

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