It refers to a severe pneumonia accompanied by shock, often caused by highly virulent Gram-positive or Gram-negative bacterial infections. The condition is critical and progresses rapidly, frequently leading to various serious complications. If not treated promptly, it can be life-threatening.

bubble_chart Diagnosis

1. Medical History and Symptoms:

In addition to respiratory symptoms, there are also symptoms such as hypotension, peripheral circulatory failure, altered mental status, and anuria.

2. Physical Examination Findings:

Signs of hypotension, mental confusion or apathy, pale complexion, cold extremities, cyanosis of the lips or fingertips, thready and rapid pulse, cold sweating, and decreased blood pressure, indicating peripheral circulatory failure; pulmonary signs consistent with pneumonia.

3. Auxiliary Examinations:

(1) Chest X-ray: Inflammatory infiltrates in the lungs (bedside imaging is preferred to avoid moving the patient).

(2) Etiological examination: Sputum smear and culture should be performed as soon as possible to identify the pathogenic bacteria.

(3) Blood tests: Elevated white blood cell count and neutrophil count, possibly with a left shift.

(3) Blood gas analysis: PaO₂, pH, standard bicarbonate (SB), and actual bicarbonate (AB) may decrease, while serum lactate may increase, indicating metabolic acidosis. In severe cases, abnormalities in routine urine tests and liver/kidney function may occur.

(4) Differential diagnosis: Should be distinguished from shock caused by other etiologies.

bubble_chart Treatment Measures

1. General Treatment:

Lie flat, administer oxygen, and keep warm.

2. Antibacterial Therapy:

The principles should be early, broad-spectrum, and effective. Before the pathogen is identified, piperacillin (piperacillin), timentin (ticarcillin plus clavulanate potassium), cefuroxime, cefotaxime, ceftazidime, ciprofloxacin, ofloxacin, etc., may be selected for treatment (refer to bacterial pneumonia). Adjust the antibacterial regimen after obtaining the results of pathogen culture and drug sensitivity tests.

3. Anti-Shock Therapy:

For patients without renal insufficiency, rapidly infuse 800–1000 ml of fluid based on the patient's heart rate, blood pressure, and urine output. Reduce the infusion rate once blood pressure rises and urine output exceeds 30 ml/h. The total fluid volume within 24 hours may reach 3000–4000 ml, primarily crystalloid solutions (normal saline, 5% glucose saline, balanced salt solution). Colloid solutions such as albumin or whole blood may be supplemented if necessary. Low-molecular-weight dextran is commonly used, with a maximum of 100 ml within 24 hours. Vasoactive drugs such as dopamine, dobutamine, metaraminol, or scopolamine may be administered as needed after adequate fluid resuscitation.

The amount of alkali supplementation is calculated as 1 mmol = 0.3 × (normal HCO₃ - measured HCO₃) × body weight (kg) (1 mmol = 2.1 ml of 4% sodium bicarbonate). Administer one-third of the calculated dose initially, then adjust based on the patient's condition and blood gas values. Alternatively, 11.2% sodium lactate or 3.63% tromethamine may be used to correct acidosis.

5. Adrenal Corticosteroids:

Hydrocortisone 200–600 mg/day or dexamethasone 10–30 mg/day, divided into doses and administered intravenously in fluids, for a course of 3–5 days. Concurrently administer ranitidine 150 mg, 1–2 times/day, to prevent stress ulcers.

6. Prevention and Treatment of Complications:

For early signs of heart failure or acute pulmonary edema, administer cedilanid 2.4 mg in 20–40 ml of 5% glucose solution by slow intravenous injection, and may add furosemide 20–40 mg simultaneously. Provide appropriate treatment for acute respiratory distress syndrome, disseminated intravascular coagulation, renal failure, or arrhythmias if they occur.