Pneumonia in the ICU Patient

Pneumonia often develops in critically ill patients in an ICU. It can also be the main reason for ICU admission.

What is Pneumonia?

Pneumonia is an infection usually caused by a bacteria. Recently, coronavirus and other viruses have caused some severe cases.

Most pneumonia patients in the ICU have a complex form involving both lungs.

The infection causes the lung to absorb water. It gets heavier, and breathing becomes very difficult.

The patient must work very hard and breathe at a very fasr rate to get any air into the lungs..

The infection can involve the air passages. as a result, pus and fluid will collect deep within the lung.

This is why the respiratory therapists work very hard to keep the lung cleaned out.

The white areas in both lungs are the pneumonia. The black area shows the right lung. The white arrow is pointing to the heart.

Causes of Pneumonia

Pneumonia frequently is a complication which results from the other problems which originally caused the patient to come to the ICU.

It seems the lungs are very sensitive and likely to develop pneumonia when there is infection elsewhere

Infections in the bloodstream or the abdomen very often lead to pneumonia.

Those with chronic lung disease of any sort including COPD are more likely to develop pneumonia. 

After major abdominal, chest, or heart surgery, patients need to get out of bed, walk cough and deep breathe.

All this prevents fluid and secretions building up in the lungs that can lead to a lung infection which we call pneumonia.

Patients at high risk include those comatose patients.

Also those not very awake or over sedated, like a comatose patient, cannot do much coughing or deep breathing.

Both these groups have a high risk for pneumonia. They require frequent respiratory care.

Effect of Pneumonia on the Patient

The water and other fluids which begin to collect in the lung increase its weight. Breathing and talking become difficult.

The patient's breathing rate dramatically increases. It becomes difficult to get enough oxygen into the blood.

As with most infections, fever often develops and the white blood cell count increases.

A lung infection can send bacteria into the blood stream and lead to  septic shock. Many other vital organs can the be affected.


Antibiotics are started as soon as possible, usually within an hour of making suspected diagnosis of pneumonia.

Cultures are taken from deep within the lung. This will often be done during a bronchoscopy.

Respiratory therapists and the nurses will keep the lung suctioned out. Various maneuvers and patient positions are used to aid this process.

Extra oxygen is given by face mask and various other devices including CPAP or Bi-PAP.

The sicker patients will require placement of a breathing tube and use of a ventilator. Ventilator patients will require some degree of sedation,

The doctors will make adjustments to care based on blood oxygen levels and x rays which are usually done at least daily.

Blood oxygen levels are continuously monitored by the bedside nurse.

The very few patients who do not respond to any of these treatments may need a type of support called ECMO.

For ECMO, large catheters are placed to move the blood through a special machine to increase oxygen levels and remove carbon dioxide.

ECMO can only be done in specialized Centers.


Typically,  pneumonia will last between 3 days and 2 weeks. Most patients will recover. Those with pre existing lung problems may be and require much longer to recover.

Non survivors generally have multiple other organ problems. Most do not die directly from pneumonia; but from other complications.

Below shows a fully recovered patient. Notice the clear lungs.

Questions to Ask

  • How long will the ventilator be needed?
  • What do the doctors think caused the pneumonia?
  • Why can't our loved one talk while he or she is on the ventilator?
  • What if he or she can't get off the ventilator?
  • What happens if the antibiotics are not working?
  • Will any more bronchoscopies be necessary?
  • What about eating while on the ventilator?
  • Is this considered life support?
  • Our loved said they never wanted to be on a machine. What should we do?
  • When would a tracheostomy be necessary?