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Community acquired pneumonia is a frequent cause of hospital admission with approximately Background -Ten years ago we published a study of 50 adults with severe community 50 000 cases presenting per year in the UK. 1Of these, most are treated on the medical ward acquired pneumonia admitted to our intensive care unit and subsequently in-without complication, but a few require transfer to the intensive care unit (ICU). troduced guidelines for the management of severe community acquired pneumoniaTen years ago we reported that severe community acquired pneumonia accounted for which are largely in accordance with those of the British Thoracic Society. The results 10% of all ICU medical admissions in our 1400 bed teaching hospital and that the mortality in of a follow up study are now reported in order to assess their impact on the out-these patients was high (54%).2 Streptococcus pneumoniae, Legionella pneumophila, and Stacome of this disease. Methods -Fifty seven cases of severe com-phylococcus aureus were the principal pathogens identified. Certain clinical and laboratory feamunity acquired pneumonia admitted to our ICU between 1984 and 1993 were stud-tures associated with severe pneumonia were identified and we noted that a quarter of ied. Causal pathogens, clinical and laboratory features of severity, antibiotic patients eventually requiring ventilation were only transferred following an unexpected cartherapy and mortality were studied and, where possible, compared with results diorespiratory arrest on the medical ward. In reporting this study we recommended and infrom the previous study. Results -Streptococcus pneumoniae, Le-stituted locally guidelines for the management of severe community acquired pneumonia and gionella pneumophila and Staphylococcus aureus were the most frequent causes of have continued to publicise these through a series of hospital newsletters, presentations, severe community acquired pneumonia, as in the previous study. The intensity of and ward notices. These emphasised the importance of full investigations, assessment of microbial investigation has increased, particularly with regard to pneumococcal poor prognostic indicators, administration of appropriate empirical antibiotics, and conand Legionella antigen testing, the latter allowing earlier diagnosis of Legionella in-sideration of early ICU transfer (fig 1). Our findings and guidelines are very similar to those fection than previously. In spite of this, no pathogen was identified in 33% of cases recently published by the British Thoracic Society (BTS) 3 following a national study of severe compared with 18% previously. Indices of severity of illness were widely recognised, community acquired pneumonia. 4 We now report a follow up study to assess the impact of and a decrease in unplanned transfers to the ICU following "unexpected" cardio-local and, indirectly, national guidelines on the outcome of severe community acquired respiratory arrest from 25% to 7% (p<0.02) was found. Antibiotic therapy largely re-pneumonia. flected ...

Therapeutic, III.

The present guideline requires formal dissemination to relevant target user groups, the development of tools for implementation into routine clinical practice and formal evaluation of the impact of the guideline on the quality of care of CTEPH patients. Moreover, the guideline will be updated periodically to reflect new evidence or clinical approaches.