Etiologic Agent

Aspiration from the oropharynx

Hematogenous spread, or by
contiguous extension from
an infected pleural or
mediastinal space

Pathogens inhaled as contaminated droplets

When barriers are overcome or when the microorganisms are small

enough to be inhaled to the alveolar level

When the capacity of the alveolar macrophages to

ingest or kill the microorganisms is exceeded
Alveolar macrophages initiate the inflammatory
response to bolster lower respiratory tract defenses

Release of inflammatory
mediators: interleukin (IL)-1
and tumor necrosis factor
(TNF)

Fever

Chemokines: IL-8, GCSF

Release of Neutrophils

If severe enough, the changes in lung

mechanics secondary to reductions in
lung volume and compliance and the
intrapulmonary shunting of blood may
cause the patient's death.

Peripheral
leukocytosis and
increased purulent
secretions
Hemoptysis

Inflammatory mediators released by macrophages + neutrophils

Alveolar
capillary leak
(initially
localized)

Rales
Radiographic infiltrate
Alveolar Filling

Increased respiratory drive

in SIRS

Respiratory Alkalosis

Dyspnea
Hypoxemia

+ Some bacterial pathogens

Severe Hypoxemia