Every year more than 25,000 Americans get hospitalized for pneumonia. If you or your loved one has been hospitalized for pneumonia, you will find this article very useful. As a hospitalist, I have admitted and taken care of thousands of adult patients with pneumonia of different severities. I am sharing the most important aspects of pneumonia in hospitalized patients based on the latest scientific facts combined with my personal experience as a doctor. Namely, you will learn when you need to be hospitalized for pneumonia and what treatments to expect based on the severity of your pneumonia. You will also get important insights into what you can do to ensure you get the best treatment for your pneumonia. Finally, you will understand the two different aspects of treating hospitalized patients with pneumonia.
The current article mainly focuses on being hospitalized for pneumonia. Please read this other article if you would like to get an overview of different types of pneumonia and their symptoms.
Should you be hospitalized for pneumonia?
Not all adults with pneumonia need hospitalization. It is important to understand why hospitalization is necessary in only certain situations. There are guidelines and criteria doctors use to make that decision but it basically come down to how sick you are. If you would like to know what kind of symptoms you need to watch out for when you are concerned about pneumonia, you may read “Pneumonia symptoms based on type and severity.”
Important things that help you decide whether you need to be hospitalized or not:
Low oxygen
If you are having shortness of breath, you most likely have low oxygen. If your regular doctor diagnosed you with pneumonia and sent you home on antibiotics, you need to call your doctor back if you develop shortness of breath after getting home. Your doctor can call the hospital and make arrangements for you to get hospitalized.
Low blood pressure
You need to pay attention to how you are feeling. If you are getting dizzy or lightheaded, you may have low blood pressure. That can be a life-threatening situation when caused by pneumonia. You will definitely need hospitalization.
Abnormal labs suggesting kidney or liver damage
Your doctor will send you to the hospital if any of the blood work is concerning for internal organ problems.
High risk factors
Even when your blood pressure and oxygen are within normal limits, doctors may decide to get you hospitalized if you have any of these risk factors:
- Old age
- Prior lung problems
- Underlying heart problems
- Struggling with cancer
- Decreased mobility
- Poor living conditions
- Living alone with a history of falls
You need to clearly communicate with your doctor about your overall heath situation if you are being evaluated in the emergency department with pneumonia. As you can see, not all situations are clear-cut. In some situations, your input may sway the ER doctor one way or the other.
What to expect when hospitalized for pneumonia
Depending on the severity of your pneumonia, you may be admitted to the general medical floor or the ICU. You can expect very different approaches to your care in those two situations.
What to expect when hospitalized to the general medical floor for pneumonia
You may be hospitalized to the general medical floor if you meet all these conditions:
- Your oxygen levels are not too low
- You are not struggling to breathe
- Your blood pressure is not too low
- You are awake and able to eat and drink normally
When hospitalized to the general medical floor for pneumonia, you can expect the following treatments:
- You will get IV antibiotics
- You may get some oxygen to help bring your oxygen levels up
- You may get some IV fluids to ensure your blood pressure does not drop
- You may have heart monitor leads attached to your chest. Heart monitors can detect abnormal changes in your heart rhythm and alert the medical staff in case of emergency.
If you start to feel worse while hospitalized on the regular medical floor, it is important to let them know right away. In 2020, you cannot simply rely on the nurses to detect when you are getting worse. The sad fact is our healthcare system is overstretched. These days, most hospitals are making it work with less than adequate numbers of nurses. They may not immediately notice when things start to worsen.
It is extremely important that you pay attention to how you feel. Call your nurse immediately if you any of these:
- Worsening shortness of breath
- New dizziness or weakness
- Lightheadedness when trying to sit up
- Breathing fast and shallow
- Feeling confused or disoriented
If you feel weak and dizzy, do not try to get up and walk. I have personally responded to many such events in hospitalized patients. It is especially important if you were not in great physical shape before you caught pneumonia.
Confusion and disorientation are very important symptoms that may indicate a need for closer monitoring of hospitalized patients with pneumonia. However, the nurses may miss confusion and disorientation if they do not know the patient well. If you are visiting your parents or loved ones who are in the hospital with pneumonia, you need to pay attention to how they are behaving. You know them better than the nurses do. You will immediately know if they are not being themselves. Please alert the nursing staff and have them contact the doctor if you detect any significant changes in their behavior.
What to expect when hospitalized to the general medical floor for pneumonia
Now, let’s explore what to expect if you are hospitalized in the ICU with pneumonia. You will be hospitalized in the ICU if you have any of these complications from pneumonia:
Problems with low oxygen
With severe pneumonia, it may be very difficult to get your oxygen up without invasive treatment. Those invasive treatments require extensive monitoring which is only possible in the intensive care unit. You may need intubation and mechanical ventilation— a tube down your air pipe connected to the breathing machine.
Problems with low blood pressure
Pneumonia may lead to severe sepsis and sharply decrease your blood pressure. If you want to understand more about sepsis, you can go to “Sepsis and severe sepsis symptoms.” When your blood pressure drops too low due to sepsis from pneumonia, you need strong medications. These artificially force your heart and blood vessels to squeeze more blood into your circulation. This can only be done in ICU with close monitoring.
Prognosis of patients hospitalized for pneumonia
Although the treatment of pneumonia has advanced significantly in the last 10 years, pneumonia is still a serious and potentially life-threatening disease. It is especially true in elderly patients with other pre-existing illnesses. On average, about 8% of patients hospitalized for pneumonia in the United States do not make it. On one study, the mortality rate of patients who were 65 years and older was even higher at 10%. As you have already learned, most patients with serious pneumonia are admitted to the ICU. It is, therefore, not surprising that almost 18% of them do not survive the illness.
Treatment aspects of hospitalized patients with pneumonia
There are 2 different aspects to treating pneumonia in hospitalized patients:
- Killing the organisms that cause pneumonia
- Supporting the patient while they recover from pneumonia
The antibiotics used in the hospital for the treatment of pneumonia depend on a number of different factors. The recommendations keep changing and are based on evolving bacteria that develop drug resistance. It is not very helpful to look at the names of the specific antibiotics they were using in 2000, but if you are curious, you can follow the link to CDC guidelines on the list of references.
This aspect of care is simply called “supportive care.” But do not let the name fool you. It is the most important treatment that makes a difference between life and death. Pneumonia itself is a treatable disease. We have the drugs to kill off the organisms that cause pneumonia. In theory, people should not die from a treatable disease. That is true, but only if we can support them while they recover from pneumonia. Most deaths happen when we can’t supply enough oxygen to the body when the lungs are swollen, or when we can’t support the blood circulation when the blood pressure drops too low.
In conclusion, pneumonia requiring hospitalization is a serious illness and it can be life-threatening. It is important for you to understand what to expect if you are admitted to the hospital with pneumonia. Hospitalized patients with pneumonia and their loved ones need to be proactive and vigilant about worsening symptoms so that those can be addressed urgently. Early intervention in hospitalized patients with severe sepsis from pneumonia can save lives.
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