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Review
, 12 Suppl 6 (Suppl 6), S2

Demographics, Guidelines, and Clinical Experience in Severe Community-Acquired Pneumonia

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Review

Demographics, Guidelines, and Clinical Experience in Severe Community-Acquired Pneumonia

Jordi Rello. Crit Care.

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.

Figures

Figure 1
Figure 1
The progressive nature of severe CAP. CAP, community-acquired pneumonia; LRTI, lower respiratory tract infection.
Figure 2
Figure 2
Pneumonia Severity Index (PSI) as a site-of-care tool. BUN, blood urea nitrogen; CHF, chronic heart failure; SBP, systolic blood pressure.
Figure 3
Figure 3
CURB-65 as a site-of-care tool. CURB-65, Confusion, Urea, Respiratory rate, Blood pressure, age ≥65 years; DBP, diastolic blood pressure; ICU, intensive care unit; SBP, systolic blood pressure.
Figure 4
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].
Figure 5
Figure 5
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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References

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