From the Guidelines
For a patient with pneumonia who is hospitalized with oxygen saturation of 90%, experiencing cough and weakness, I recommend starting empiric antibiotic therapy based on likely pathogens and considering supplemental oxygen to maintain saturation ≥92%. Regarding steroids, the use of systemic corticosteroids in patients with pneumonia requiring oxygen is supported by recent guidelines 1. The European Respiratory Society living guideline recommends offering treatment with corticosteroids for patients with COVID-19 requiring oxygen, noninvasive ventilation, or invasive mechanical ventilation, with a strong recommendation and moderate quality of evidence 1. However, the decision to use corticosteroids should be individualized based on severity, comorbidities, and risk factors, as they carry risks including hyperglycemia, secondary infections, and gastrointestinal bleeding. Some studies suggest that corticosteroids may not improve outcomes in patients with COVID-19, but may be beneficial in reducing the duration of fever and improving oxygenation 1. The Surviving Sepsis Campaign guidelines suggest using low-dose corticosteroid therapy for adults with COVID-19 and refractory shock, but do not recommend routine use of systemic corticosteroids for mechanically ventilated adults with COVID-19 and respiratory failure without ARDS 1. Key considerations for the patient's management include:
- Starting empiric antibiotic therapy based on likely pathogens
- Providing supplemental oxygen to maintain saturation ≥92%
- Considering the use of systemic corticosteroids based on individual patient factors and severity of illness
- Monitoring vital signs, oxygen requirements, and clinical response closely.
From the Research
Patient Management
For a patient diagnosed with pneumonia, inpatient, with an oxygen saturation of 90%, complaining of cough and weakness, the following management options can be considered:
- Oxygen therapy: According to 2, oxygen saturations less than 90% are associated with major adverse events in outpatients with pneumonia. Therefore, oxygen therapy is crucial in this case.
- Non-invasive ventilation: As stated in 3 and 4, non-invasive ventilation can be beneficial for patients with hypoxemic respiratory failure, including those with pneumonia.
- High-flow nasal cannula oxygen therapy: Studies such as 5 and 6 suggest that high-flow nasal cannula oxygen therapy can be effective in managing patients with pneumonia and mild hypoxaemia.
Use of Steroids
There is no direct evidence in the provided studies to support the use of steroids in this specific patient case. However, steroids are sometimes used in the treatment of pneumonia to reduce inflammation, but this decision should be made based on individual patient needs and medical history.
Monitoring and Treatment
The patient's condition should be closely monitored, and treatment should be adjusted accordingly. This may include:
- Continuous monitoring of oxygen saturation and other vital signs
- Adjusting oxygen therapy as needed
- Considering non-invasive ventilation or high-flow nasal cannula oxygen therapy if the patient's condition worsens
- Evaluating the patient's response to treatment and making adjustments as necessary