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Suggest Treatment For Anaerobic Pneumonia
Question: Greetings,
My mom is on a vent due to a terrible pneumonia that she suffered. Her chances of getting off of the vent are not good. However, she wants to be able to eat and drink etc. she is at a rehabilitative center right now. The speech therapist there does not really want to deflate her cuff to do a swallow test until her tidal volume is higher and/or is weened. She can hold her 02 sat when they disconnect her from the vent to change out the tubes. Want not just do a swallow test and see what happens?
My mom is on a vent due to a terrible pneumonia that she suffered. Her chances of getting off of the vent are not good. However, she wants to be able to eat and drink etc. she is at a rehabilitative center right now. The speech therapist there does not really want to deflate her cuff to do a swallow test until her tidal volume is higher and/or is weened. She can hold her 02 sat when they disconnect her from the vent to change out the tubes. Want not just do a swallow test and see what happens?
Brief Answer:
Please answer my queries
Detailed Answer:
Hello
Thanks for your query.
Please answer my following queries -
1. For how long is she on ventilator?
2. Is etiology of her pneumonia diagnosed?
3. How long she can hold her 02 saturation after disconnecting the ventilator?
4. What is her present electrolyte status?
5. How many times in a day spontaneous breathing trial was attempted?
6. What is her present hemodynamic status?
7. Is there any underlying co-morbidity?
8. When CLL and NSCLC were diagnosed to her and what is their present status?
I need to have a proper answer to all my queries to understand the exact situation of your mom. I am eagerly waiting for your answer.
Thank you.
Regards,
Dr Arnab Maji
Pulmonologist
Please answer my queries
Detailed Answer:
Hello
Thanks for your query.
Please answer my following queries -
1. For how long is she on ventilator?
2. Is etiology of her pneumonia diagnosed?
3. How long she can hold her 02 saturation after disconnecting the ventilator?
4. What is her present electrolyte status?
5. How many times in a day spontaneous breathing trial was attempted?
6. What is her present hemodynamic status?
7. Is there any underlying co-morbidity?
8. When CLL and NSCLC were diagnosed to her and what is their present status?
I need to have a proper answer to all my queries to understand the exact situation of your mom. I am eagerly waiting for your answer.
Thank you.
Regards,
Dr Arnab Maji
Pulmonologist
Above answer was peer-reviewed by :
Dr. Prasad
Thank-you very much Dr. XXXXXXX for your reply. If I don't get some of your questions right, please let me know so I can give you the correct information.
1) on May 8th it will be 2 months.
2) no, not even after two Bronchs. The pathologist that analyzed the secretions did see a neophile attacking some yeast that was in the lung but the doctor who specializes in infectious diseases explained that the yeast was in the lung due to a confluence of different IV antibiotics they used to treat my mother's congestion until she fell seriously ill. Tested for PCP, Legionaire's etc.
3) you know I am nit really sure because no one has really tried that except when changing out tubes etc. So much longer than when her respiratory failure occurred that I know for sure. Once disconnected from Oxygen, her 02 sat would sink like a stone.
4) needs some oral potassium every other day or so but otherwise ok.
5) she is on simv now---f10 v600 vent at 40%. Have not done cpap in awhile since my mom's tidal volume is low and has not been able to pass.
6) Not sure if I am going to hit the nail on the head here--red blood cell count within average and white cell count 48k at present.
7) some evidence of copd but quit smoking in 2002.
8) except for feeling a little tired, copd has never required any treatment. My mom responded very well to LC treatment. Her pet scan in October was almost normal. Only a lesion on c-1 lit up. However, another one done in December indicated that there was some progression-both the site of her original tumer in her left lung lit up and a small area in her lower spine. My mom was being treated with alimta in January every three weeks with her last treatment on January 30th. Squamous cell histology
One more thing--my mom's pneumonia was in her right lung. I was told by my mom's Pulmonologist that there is no evidence of cancer in her right lung.
1) on May 8th it will be 2 months.
2) no, not even after two Bronchs. The pathologist that analyzed the secretions did see a neophile attacking some yeast that was in the lung but the doctor who specializes in infectious diseases explained that the yeast was in the lung due to a confluence of different IV antibiotics they used to treat my mother's congestion until she fell seriously ill. Tested for PCP, Legionaire's etc.
3) you know I am nit really sure because no one has really tried that except when changing out tubes etc. So much longer than when her respiratory failure occurred that I know for sure. Once disconnected from Oxygen, her 02 sat would sink like a stone.
4) needs some oral potassium every other day or so but otherwise ok.
5) she is on simv now---f10 v600 vent at 40%. Have not done cpap in awhile since my mom's tidal volume is low and has not been able to pass.
6) Not sure if I am going to hit the nail on the head here--red blood cell count within average and white cell count 48k at present.
7) some evidence of copd but quit smoking in 2002.
8) except for feeling a little tired, copd has never required any treatment. My mom responded very well to LC treatment. Her pet scan in October was almost normal. Only a lesion on c-1 lit up. However, another one done in December indicated that there was some progression-both the site of her original tumer in her left lung lit up and a small area in her lower spine. My mom was being treated with alimta in January every three weeks with her last treatment on January 30th. Squamous cell histology
One more thing--my mom's pneumonia was in her right lung. I was told by my mom's Pulmonologist that there is no evidence of cancer in her right lung.
Brief Answer:
Ventilator dependency, tracheostomy
Detailed Answer:
Hello
Thanks for your query.
Your mom was probably suffering from anaerobic pneumonia which can not be detected unless bronchoscopic samples are sent for anaerobic culture. Moreover there might be a super-added fungal infection which gave you that pathological analysis.
Presently your mom is ventilator dependent the causes of which your doctor, I think, should have already addressed and evaluated. As 2 month time is approaching I think it's the time to go for tracheostomy because prolonged endo-tracheal intubation may cause many tube related complications like tracheal ischemia, stenosis and fistula. Inability to maintain Sp02 is probably because of diaphragmatic paralysis or fatigue, improper nutrition or cardiac disorder which need to be evaluated in-detail. I think from SIMV mode your mom needs to be shifted to pressure support ventilation (PSV) and should have a continuous attempt of weaning. But doctors should be very much judicious because improper extubation may enhance the chance of re-intubation which will harm more. Therefore weaning attempt should be there but it should not be early and improper. You should discuss these issues with your pulmonologist.
If you want to know further you can write back to me.
If you are happy with my response you can write a review for me.
Thank you.
Regards.
Dr Arnab Maji
Ventilator dependency, tracheostomy
Detailed Answer:
Hello
Thanks for your query.
Your mom was probably suffering from anaerobic pneumonia which can not be detected unless bronchoscopic samples are sent for anaerobic culture. Moreover there might be a super-added fungal infection which gave you that pathological analysis.
Presently your mom is ventilator dependent the causes of which your doctor, I think, should have already addressed and evaluated. As 2 month time is approaching I think it's the time to go for tracheostomy because prolonged endo-tracheal intubation may cause many tube related complications like tracheal ischemia, stenosis and fistula. Inability to maintain Sp02 is probably because of diaphragmatic paralysis or fatigue, improper nutrition or cardiac disorder which need to be evaluated in-detail. I think from SIMV mode your mom needs to be shifted to pressure support ventilation (PSV) and should have a continuous attempt of weaning. But doctors should be very much judicious because improper extubation may enhance the chance of re-intubation which will harm more. Therefore weaning attempt should be there but it should not be early and improper. You should discuss these issues with your pulmonologist.
If you want to know further you can write back to me.
If you are happy with my response you can write a review for me.
Thank you.
Regards.
Dr Arnab Maji
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you very much Dr. Maji and I will write a great review. But just to let you know, my mom did have a tracheotomy 5 weeks ago. No one ever suggested anaerobic pneumonia. The Doctor over seeing her care just reduced her to 35% of the vents oxygen capacity but still on SIMV. I realize that the healing process is different and there is no way to say for sure, but will this type of pneumonia cause a great deal of scar tissue in my mom's lung?
Brief Answer:
Don't worry, keep patience and faith on doctors
Detailed Answer:
Hello
Thanks for writing back.
Right lung pneumonia in this age group with multiple co-morbidities is one of ideal conditions for aspiration pneumonia which is surely a stronger possibility here and aspiration pneumonia in many cases may lead to necrosis of lung parenchyma leading to secondary infection like fungal pneumonia and subsequent scar formation. The typical locations of aspiration pneumonia are right lower lobe apical segment or posterior segment of right upper lobe. In general aged patients with co-morbidities usually have a slow healing process and prolonged recovery time. The improvement in your mom is slow but improvement is there and I think your doctors will rightly and sincerely handle the case. Don't worry much. One thing I should point out here is that in the cases where it is already a case of ventilator dependency it may take much more time for weaning unexpectedly. I think your doctors are very much efficient in managing a ventilator dependent patient and addressing the complications as a consequence. Probably they will have an attempt to shift your mom from SIMV to PSV mode. Therefore you should not panic. Keep faith on your doctors and God.
If you have further queries you can write back to me without hesitation.
Thank you.
Regards,
Dr Arnab Maji
Don't worry, keep patience and faith on doctors
Detailed Answer:
Hello
Thanks for writing back.
Right lung pneumonia in this age group with multiple co-morbidities is one of ideal conditions for aspiration pneumonia which is surely a stronger possibility here and aspiration pneumonia in many cases may lead to necrosis of lung parenchyma leading to secondary infection like fungal pneumonia and subsequent scar formation. The typical locations of aspiration pneumonia are right lower lobe apical segment or posterior segment of right upper lobe. In general aged patients with co-morbidities usually have a slow healing process and prolonged recovery time. The improvement in your mom is slow but improvement is there and I think your doctors will rightly and sincerely handle the case. Don't worry much. One thing I should point out here is that in the cases where it is already a case of ventilator dependency it may take much more time for weaning unexpectedly. I think your doctors are very much efficient in managing a ventilator dependent patient and addressing the complications as a consequence. Probably they will have an attempt to shift your mom from SIMV to PSV mode. Therefore you should not panic. Keep faith on your doctors and God.
If you have further queries you can write back to me without hesitation.
Thank you.
Regards,
Dr Arnab Maji
Above answer was peer-reviewed by :
Dr. Yogesh D
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