A bout of pneumonia happens in four stages: congestion, red hepatization, grey hepatization, and resolution.
The names of each stage refer to how the infection progresses over time.
The initial congestion stage is characterized by a wet cough, chest pain, and fever.
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Symptoms usually worsen in the hepatization stages, and you may have difficulty breathing.
The infection typically resolves within one to two weeks.
Most of this congestion takes place during the first 24 hours after the infection develops.
It’s more common than the other form of pneumoniaviral pneumoniawhich is sparked by viruses.
Symptoms
The congestion stage of pneumonia may start suddenly or gradually.
This can be very alarming and warrants immediate medical attention in any case.
Children often experience many of the same symptoms as adults.
However, in some cases, the only symptom a child has is rapid breathing.
Children may also develop a lack of appetite, which can lead to dehydration.
Management/Treating Symptoms
Once diagnosed, antibiotics should be started almost immediately.
Blood cultures (blood tests done to see if bacteria are present in the blood) are often done.
If the infection is found to be bacterial, then antibiotic treatment will likely be started right away.
When antibiotics are started promptly after symptoms begin, the infection may resolve within 48 to 72 hours.
Depending on the severity, hospital admission or intensive care unit (ICU) admission may be needed.
This is especially true if a person has hypoxia or difficulty breathing.
Intravenous (IV) fluids may also be needed.
Depending on the severity, oxygen supplementation may be needed, as well as admission to the ICU.
Reduced oxygen levels also cause the lungs to become dry and firm, much like a liver.
The term “hepatization” refers to this liver-like appearance.
During red hepatization, symptoms are usually more severeeveniftreatment has been started.
These can include:
In older adults, confusion or delirium may appear even despite oxygen therapy.
A respiratory rate greater than 30 breaths per minute often means that hospitalization in intensive care is needed.
Oxygen may be started at this point or continued in those who already have low oxygen levels.
In some cases, oxygen alone may be insufficient.
A first step may be to usenoninvasive positive pressure ventilationsuch as CPAP (continuous positive airway pressure).
Withpneumococcalpneumonia, up to 25% to 30% of people will have bacteremia.
With septicemia, a person will appear extremely ill, often with a very rapid pulse and confusion.
In contrast to septicemia,sepsisrefers to the body’s response to bacteria in the bloodstream.
This overwhelming response of the immune system is very critical.
Significant research is focusing on ways to prevent sepsis from occurring.
Empyema
Inflammation can result in the buildup of fluid in the lining of the lung (pleural effusion).
When an empyema is present, athoracentesisis often the next step.
Achest tubemay be needed for a large empyema.
What are the Last Stages of Pneumonia Before Death?
End-stage pneumonia typically involves severe respiratory distress, requiring supplemental oxygen.
Signs of oxygen deprivation, such as blue skin and an altered mental state, are usually apparent.
Sepsis followed by multiple organ failure may occur and quickly lead to death.
The lungs will become drier and continue to have a liver-like consistency.
During grey hepatization, many of the same symptoms experienced in red hepatization will persist.
Breathing may become especially difficult, necessitating additional oxygen therapy or mechanical ventilation.
Fits of coughing may become more severe and produce blood.
During grey hepatization, antibiotics (for bacterial pneumonia) will be continued.
For those who are improving and in the hospital, intravenous antibiotics may be exchanged for oral antibiotics.
For those who have a severe infection, alung abscessmay form.
What Are the Worst Days of Pneumonia?
Pneumonia can be unpredictable and complications may occur at any time.
For others,recoverycan take a month or longer.
Most people continue to feel tired for about a month.
Antibiotics are usually continued for at least 10 days.
If antibiotics were previously given intravenously, they may be changed to oral tablets.
For those who were hospitalized, many can be discharged (if not discharged already).
For those who continue to worsen, oxygen or mechanical ventilation may need to be started at this time.
In some cases, oxygen therapy will be needed long-term.
For example, it could cause problems with pleural effusions or lung cancer surgery down the road.
For some people, lung damage may persist, requiring long-term oxygen supplementation.
Severe pneumonia may also worsen underlying chronic obstructive pulmonary disease (COPD).
How Can You Tell if Pneumonia Is Getting Better or Worse?
Most people with pneumonia start to feel better within a few days of starting treatment with antibiotics.
It is a good sign that you are recovering if your temperature returns to normal within seven days.
You should be coughing less, breathing better, and feeling less chest pressure as time goes on.
Contact your healthcare provider if this isn’t the case.
The names of each stage refer to how the infection affects the lungs.
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