Management of severe community-acquired pneumonia in Brazil: a secondary analysis of an international survey

Abstract

ObjectiveThis study aimed to evaluate Brazilian physicians’ perceptions regarding the diagnosis, severity assessment, treatment and risk stratification of severe community-acquired pneumonia patients and to compare those perceptions to current guidelines.MethodsWe conducted a cross-sectional international anonymous survey among a convenience sample of critical care, pulmonary, emergency and internal medicine physicians from Brazil between October and December 2008. The electronic survey evaluated physicians’ attitudes towards the diagnosis, risk assessment and therapeutic interventions for patients with severe community-acquired pneumonia.ResultsA total of 253 physicians responded to the survey, with 66% from Southeast Brazil. The majority (60%) of the responding physicians had > 10 years of medical experience. The risk assessment of severe community-acquired pneumonia was very heterogeneous, with clinical evaluation as the most frequent approach. Although blood cultures were recognized as exhibiting a poor diagnostic performance, these cultures were performed by 75% of respondents. In contrast, the presence of urinary pneumococcal and Legionella antigens was evaluated by less than 1/3 of physicians. The vast majority of physicians (95%) prescribe antibiotics according to a guideline, with the combination of a 3rd/4th generation cephalosporin plus a macrolide as the most frequent choice.ConclusionThis Brazilian survey identified an important gap between guidelines and clinical practice and recommends the institution of educational programs that implement evidence-based strategies for the management of severe community-acquired pneumonia.

Charlson Comorbidity Index and other predictors of in-hospital mortality among adults with community-acquired pneumonia

“…(20) As ASC observadas no presente estudo são semelhantes às descritas anteriormente para o CURB-65 (0,73 a 0,76) e o PSI (0,70 a 0,80). (11,(21)(22)(23)(24) O uso de modelos de predição de risco é respaldado por diretrizes de manejo da PAC. (7)(8)(9) No entanto, a gravidade da PAC é geralmente determinada por meio de avaliação clínica, (21) que é frequentemente realizada sem o apoio de uma ferramenta estruturada objetiva.…”

“…(7)(8)(9) No entanto, a gravidade da PAC é geralmente determinada por meio de avaliação clínica, (21) que é frequentemente realizada sem o apoio de uma ferramenta estruturada objetiva. (22) Nesse sentido, o ICC tem a vantagem de fazer parte da avaliação usual de gravidade em serviços de emergência e, consequentemente, não precisa ser introduzido na rotina de assistência ao paciente para avaliar indivíduos com pneumonia. Além disso, como não exige exames laboratoriais, o ICC é adequado para uso em contextos de emergência.…”

“… 7 - 9 However, the detection of CAP severity is usually determined by clinical assessment, 21 which is frequently performed without the support from an objective, structured tool. 22 In this sense, the CCI has the advantage of being part of the usual assessment of severity in emergency services and, consequently, does not need to be introduced in the routine of patient care for the assessment of individuals with pneumonia. In addition, since the CCI does not require laboratory tests, it is appropriate for use in emergency settings.…”

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)

“…Any component that is added after the Y piece increases dead space and may have clinical relevance [ 199 ].…”