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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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Related in: MedlinePlus

A care bundle for management of severe CAP patients in the emergency department. CAP, community-acquired pneumonia; ICU, intensive care unit.
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Figure 5: A care bundle for management of severe CAP patients in the emergency department. CAP, community-acquired pneumonia; ICU, intensive care unit.

Mentions: The data presented here, based in part on our own research experience, suggest that a care bundle for severe CAP patients – incorporating the key elements shown in Figure 5 – would be a valuable tool. Risk assessment should include pulse oxymetry and point-of-care lactate for early identification of hypoxemia or hypoperfusion. This should be followed by a combination of measures aimed at reducing bacterial load (antibiotics) and improving oxygenation and microcirculation. Identification of patients who are at risk for invasive respiratory and vasopressor support is crucial because delayed ICU admission is associated with reduced survival. Newer tools for risk stratification, such as the PIRO score, would enhance recognition of patients who require adjunctive therapy. Incorporating microbiologic information, with early detection of bacteremia using polymerase chain reaction and DNAemia, will be the next steps in enhancing management of severe CAP.


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

Rello J - Crit Care (2008)

A care bundle for management of severe CAP patients in the emergency department. CAP, community-acquired pneumonia; ICU, intensive care unit.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 5: A care bundle for management of severe CAP patients in the emergency department. CAP, community-acquired pneumonia; ICU, intensive care unit.
Mentions: The data presented here, based in part on our own research experience, suggest that a care bundle for severe CAP patients – incorporating the key elements shown in Figure 5 – would be a valuable tool. Risk assessment should include pulse oxymetry and point-of-care lactate for early identification of hypoxemia or hypoperfusion. This should be followed by a combination of measures aimed at reducing bacterial load (antibiotics) and improving oxygenation and microcirculation. Identification of patients who are at risk for invasive respiratory and vasopressor support is crucial because delayed ICU admission is associated with reduced survival. Newer tools for risk stratification, such as the PIRO score, would enhance recognition of patients who require adjunctive therapy. Incorporating microbiologic information, with early detection of bacteremia using polymerase chain reaction and DNAemia, will be the next steps in enhancing management of severe CAP.

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