What are the non-pharmacologic (non-medication) management strategies for in-patient treatment of pneumonia?

Non-Pharmacologic In-Patient Management of Pneumonia

Non-pharmacologic management strategies are essential components of comprehensive pneumonia care and should be implemented alongside appropriate antibiotic therapy to optimize patient outcomes and reduce mortality. 1

Respiratory Support

• Oxygen therapy should be provided to maintain oxygen saturation ≥92%, as saturations below this threshold are associated with increased morbidity and mortality 2
• Non-invasive ventilation (NIV) should be considered for patients with hypoxemia or respiratory distress unless they require immediate intubation due to severe hypoxemia (PaO₂/FiO₂ ratio <150) and bilateral alveolar infiltrates 1, 3
• Low-tidal-volume ventilation (6 cm³/kg of ideal body weight) should be used for patients requiring mechanical ventilation who have diffuse bilateral pneumonia or acute respiratory distress syndrome 1

Early Mobilization and Fluid Management

• Early mobilization should be implemented for all patients to prevent complications of bed rest and accelerate recovery 1
• Low molecular weight heparin should be administered to patients with acute respiratory failure to prevent thromboembolic complications 1
• Adequate fluid resuscitation is essential for hypotensive patients with severe pneumonia 1

Monitoring and Assessment

• Regular assessment of clinical stability including temperature, respiratory rate, blood pressure, oxygen saturation, and mental status should be performed 1
• Screening for occult adrenal insufficiency should be considered in hypotensive, fluid-resuscitated patients with severe CAP 1
• Structured reassessment of non-responding patients (those without clinical improvement after 48-72 hours of appropriate therapy) is necessary to identify potential complications or alternative diagnoses 4

Transition of Care

• Switch from intravenous to oral therapy when patients are:

  • Hemodynamically stable and improving clinically
  • Able to ingest medications
  • Have a normally functioning gastrointestinal tract 1

• Discharge planning should begin when patients are clinically stable, with no other active medical problems, and have a safe environment for continued care 1

  • Inpatient observation while receiving oral therapy is not necessary once clinical stability is achieved 1

Infection Control Measures

• Droplet precautions and careful routine infection control measures should be implemented for patients with suspected influenza or other respiratory pathogens 1
• Isolation precautions appropriate to the suspected pathogen should be maintained until the infectious risk is resolved 1

Follow-up Care

• Clinical review should be arranged for all patients at around 6 weeks, either with their general practitioner or in a hospital clinic 1
• Follow-up chest radiograph should be obtained approximately 4-6 weeks after hospital discharge to establish a new radiographic baseline and exclude underlying malignancy, particularly in older smokers 1
• Patients should be offered access to information about pneumonia such as a patient information leaflet at discharge or follow-up 1

Special Considerations

• For aspiration pneumonia, additional non-pharmacologic measures may include:

  • Elevation of the head of the bed
  • Careful attention to feeding strategies
  • Speech therapy consultation for swallowing assessment 1

• For non-responding pneumonia, consider:

  • Repeat imaging (chest CT) to identify complications such as empyema
  • Bronchoscopy to obtain additional samples or remove retained secretions 1, 4

By implementing these evidence-based non-pharmacologic strategies alongside appropriate antimicrobial therapy, clinicians can optimize outcomes for patients hospitalized with pneumonia and reduce the risk of complications and mortality.