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Demographics, guidelines, and clinical experience in severe community-acquired pneumonia.

Rello J - Crit Care (2008)

Bottom Line: Mortality in patients with community-acquired pneumonia (CAP) who require intubation or support with inotropes in an intensive care unit setting remains extremely high (up to 50%).Systematic use of objective severity-of-illness criteria, such as the Pneumonia Severity Index (PSI), British Thoracic Society CURB-65 (an acronym meaning Confusion, Urea, Respiratory rate, Blood pressure, age >/=65 years), or criteria developed by the Infectious Diseases Society of America/American Thoracic Society, to aid site-of-care decisions for pneumonia patients is emerging as a step forward in patient management.Experience with the Predisposition, Infection, Response, and Organ dysfunction (PIRO) score, which incorporates key signs and symptoms of sepsis and important CAP risk factors, may represent an improvement in staging severe CAP.

View Article: PubMed Central - HTML - PubMed

Affiliation: Critical Care Department, Joan XXIII University Hospital University Rovira i Virgili, Pere Virgili Health Institut, CIBER Enfermedades Respiratorias (CIBERES), Tarragona 43007, Spain. jrello.hj23.ics@gencat.cat

ABSTRACT
Mortality in patients with community-acquired pneumonia (CAP) who require intubation or support with inotropes in an intensive care unit setting remains extremely high (up to 50%). Systematic use of objective severity-of-illness criteria, such as the Pneumonia Severity Index (PSI), British Thoracic Society CURB-65 (an acronym meaning Confusion, Urea, Respiratory rate, Blood pressure, age >/=65 years), or criteria developed by the Infectious Diseases Society of America/American Thoracic Society, to aid site-of-care decisions for pneumonia patients is emerging as a step forward in patient management. Experience with the Predisposition, Infection, Response, and Organ dysfunction (PIRO) score, which incorporates key signs and symptoms of sepsis and important CAP risk factors, may represent an improvement in staging severe CAP. In addition, it has been suggested that implementing a simple care bundle in the emergency department will improve management of CAP, using five evidence-based variables, with immediate pulse oxymetry and oxygen assessment as the cornerstone and initial step of treatment.

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PIRO as a mortality risk assessment tool. ARDS, acute respiratory distress syndrome; CAP, community-acquired pneumonia; COPD, chronic obstructive pulmonary disease; ICU, intensive care unit; PIRO, Predisposition, Infection, Response, and Organ dysfunction. Reproduced with permission from Rello and coworkers [36].
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Figure 4: PIRO as a mortality risk assessment tool. ARDS, acute respiratory distress syndrome; CAP, community-acquired pneumonia; COPD, chronic obstructive pulmonary disease; ICU, intensive care unit; PIRO, Predisposition, Infection, Response, and Organ dysfunction. Reproduced with permission from Rello and coworkers [36].

Mentions: We have developed an adaptation of the PIRO score that is applicable in the setting of severe CAP, arbitrarily determining a score for the features of severe CAP (Figure 4) [36]. The PIRO system takes into account risk factors, most notably the presence of COPD, in accordance with results showing that CAP patients admitted to ICUs with COPD have a worse prognosis and a worse 28-day survival compared with non-COPD patients [24]. Validation of the PIRO score revealed an excellent correlation between increasing PIRO score and mortality rate (P < 0.001), and between increasing PIRO score and health care resource utilization in terms of the need for mechanical ventilation and length of stay in the ICU (P < 0.001).


Demographics, guidelines, and clinical experience in severe community-acquired pneumonia.

Rello J - Crit Care (2008)

PIRO as a mortality risk assessment tool. ARDS, acute respiratory distress syndrome; CAP, community-acquired pneumonia; COPD, chronic obstructive pulmonary disease; ICU, intensive care unit; PIRO, Predisposition, Infection, Response, and Organ dysfunction. Reproduced with permission from Rello and coworkers [36].
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2607112&req=5

Figure 4: PIRO as a mortality risk assessment tool. ARDS, acute respiratory distress syndrome; CAP, community-acquired pneumonia; COPD, chronic obstructive pulmonary disease; ICU, intensive care unit; PIRO, Predisposition, Infection, Response, and Organ dysfunction. Reproduced with permission from Rello and coworkers [36].
Mentions: We have developed an adaptation of the PIRO score that is applicable in the setting of severe CAP, arbitrarily determining a score for the features of severe CAP (Figure 4) [36]. The PIRO system takes into account risk factors, most notably the presence of COPD, in accordance with results showing that CAP patients admitted to ICUs with COPD have a worse prognosis and a worse 28-day survival compared with non-COPD patients [24]. Validation of the PIRO score revealed an excellent correlation between increasing PIRO score and mortality rate (P < 0.001), and between increasing PIRO score and health care resource utilization in terms of the need for mechanical ventilation and length of stay in the ICU (P < 0.001).

Bottom Line: Mortality in patients with community-acquired pneumonia (CAP) who require intubation or support with inotropes in an intensive care unit setting remains extremely high (up to 50%).Systematic use of objective severity-of-illness criteria, such as the Pneumonia Severity Index (PSI), British Thoracic Society CURB-65 (an acronym meaning Confusion, Urea, Respiratory rate, Blood pressure, age >/=65 years), or criteria developed by the Infectious Diseases Society of America/American Thoracic Society, to aid site-of-care decisions for pneumonia patients is emerging as a step forward in patient management.Experience with the Predisposition, Infection, Response, and Organ dysfunction (PIRO) score, which incorporates key signs and symptoms of sepsis and important CAP risk factors, may represent an improvement in staging severe CAP.

View Article: PubMed Central - HTML - PubMed

Affiliation: Critical Care Department, Joan XXIII University Hospital University Rovira i Virgili, Pere Virgili Health Institut, CIBER Enfermedades Respiratorias (CIBERES), Tarragona 43007, Spain. jrello.hj23.ics@gencat.cat

ABSTRACT
Mortality in patients with community-acquired pneumonia (CAP) who require intubation or support with inotropes in an intensive care unit setting remains extremely high (up to 50%). Systematic use of objective severity-of-illness criteria, such as the Pneumonia Severity Index (PSI), British Thoracic Society CURB-65 (an acronym meaning Confusion, Urea, Respiratory rate, Blood pressure, age >/=65 years), or criteria developed by the Infectious Diseases Society of America/American Thoracic Society, to aid site-of-care decisions for pneumonia patients is emerging as a step forward in patient management. Experience with the Predisposition, Infection, Response, and Organ dysfunction (PIRO) score, which incorporates key signs and symptoms of sepsis and important CAP risk factors, may represent an improvement in staging severe CAP. In addition, it has been suggested that implementing a simple care bundle in the emergency department will improve management of CAP, using five evidence-based variables, with immediate pulse oxymetry and oxygen assessment as the cornerstone and initial step of treatment.

Show MeSH
Related in: MedlinePlus