8 9 Multiple scoring systems provide support in deciding the site of care, but most of these tools predict mortality risk, and not specifically the need for intensive care admission. Severe community acquired pneumonia (SCAP)Įarly identification of patients with SCAP is critical to provide rapid, definitive treatment and to avoid delay in providing intensive care treatment, in an effort to reduce mortality.
In this article, we review current knowledge on the management of pneumonia in critically ill patients, including CAP and HAP, focusing on epidemiology, microbial etiology, pathogenesis, treatment, and prevention. Prompt and adequate antimicrobial treatment is crucial for the best outcomes in critically ill patients with severe pneumonia, and is a key focus of international guidelines for the management of pneumonia. However, in most patients, identifying the cause is challenging, especially in those with chronic underlying disease, those who received previous antibiotic therapy, and those treated with mechanical ventilation. Identifying a pathogen is critical for antimicrobial stewardship in critically ill patients with severe pneumonia. 3 4 Appropriate diagnosis of severe pneumonia is crucial to improve survival of critically ill patients. Severe pneumonia is associated with high short and long term mortality, and those who survive often have important sequelae such as alterations of lung function, reduction in mental and cognitive functions, weakness and reduction of motor function, and reduced functional autonomy. 1 2 Pneumonia in critically ill patients may present as pneumonia acquired in the community (community acquired pneumonia, CAP) pneumonia acquired in the hospital (hospital acquired pneumonia, HAP) or pneumonia related to mechanical ventilation (ventilator associated pneumonia, VAP). It is also the leading infectious disease cause of mortality among all ages worldwide. Pneumonia is a major health problem, being associated with high morbidity and short and long term mortality. Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different perspectives on host immunological responses, assessment of illness severity, microbial causes, risk factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options.
Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia. Furthermore, as antimicrobial therapy must be empiric, national and international guidelines recommend initial antimicrobial treatment according to the location’s epidemiology for patients admitted to the intensive care unit, specific recommendations on disease management are available. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease those who received previous antibiotic treatment and those treated with mechanical ventilation. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications.
0 kommentar(er)
