Severe community-acquired pneumonia in ICUs: Prospective validation of a prognostic score

Abstract

This index, which performs well in classifying patients at high-risk of death, may help physicians in initial patient care (appropriateness of the initial antimicrobial therapy) and guide future clinical research (analysis and design of therapeutic trials).

BTS Guidelines for the Management of Community Acquired Pneumonia in Adults

“…Nearly all of the patients required assisted ventilation. By contrast, the mortality rate in a large multicentre study of severe CAP in four French ICUs reported a mortality rate of 35% with a ventilation rate of only 52%74 [ Ib ]. Similar figures were reported from another ICU based study in France75[ II ].…”

“…In the intensive care setting septic shock, defined as (a) a sustained decrease (for at least 1 hour) in systolic blood pressure of at least 40 mm Hg from baseline or (b) a resultant systolic blood pressure of <90 mm Hg after adequate volume replacement in the absence of antihypertensive drugs occurring more than 12 hours after admission to the ICU is an additional adverse sign74 [ II ],185 [ II ].…”

“…Respiratory failure and the need for mechanical ventilation, whether upon admission to the ICU or subsequently, is a predictor of mortality in itself43 [ Ib ],67 [ II ],74 [ Ib ],75 [ II ].…”

“…Bilateral involvement or the involvement of more than two lobes on the chest radiograph are poor prognostic factors43 [ Ib ],74 [ III , Ib ],179 [ Ia ],184 [ Ib ],188 [ III ],193 [ II ]. The presence of bilateral parapneumonic effusions has also been associated with an increased risk of death in one large study195[ Ib ].…”

“…A positive blood culture, regardless of the pathogen isolated, is associated with a poor outcome43 [ Ib ],67 [ II ],74 [ Ib ],75 [ II ],179 [ Ia ],188 [ III ],194 [ III ]. In bacteraemic patients, pathogens particularly associated with severe disease include S pneumoniae, Gram negative enteric bacilli, S aureus , and P aeruginosa 11 [ II ],43 [ Ib ],67 [ II ],75 [ II ].…”