Monitoring

Due to a lack of specific guidance on monitoring for patients with HAP, the following recommendations have been extrapolated from the British Thoracic Society guidelines on community-acquired pneumonia.[34]

Measure observations initially at least twice daily, and more frequently (e.g., every hour) in those admitted to a critical care unit (high-dependency unit or ICU).[34] Monitor:

  • Pulse

  • Blood pressure

  • Respiratory rate

  • Temperature

  • Oxygen saturation (with a recording of the inspired oxygen saturation at the same time)

  • Mental status.

Consider measuring C-reactive protein concentration if clinical progress is uncertain after 48 to 72 hours.[34]

Review all patients with severe symptoms at least every 12 hours until clinical improvement occurs.[34] This should be done by a senior colleague and the medical team.[34]

Reassess patients if symptoms do not improve as expected or worsen rapidly or significantly.[7] 

Seek specialist advice from a microbiologist if the patient has symptoms that are not improving as expected with antibiotics or has multidrug-resistant bacteria.[7]

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