Severe community-acquired pneumonia: timely management measures in the first 24 hours

Abstract

Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools. The bundles include early guideline-concordant antibiotics including macrolides, early haemodynamic support (lactate measurement, intravenous fluids, and vasopressors), and early respiratory support (high-flow nasal cannulae, lung-protective ventilation, prone positioning, and neuromuscular blockade for acute respiratory distress syndrome).While the proposed interventions appear straightforward, multiple barriers to their implementation exist. To successfully decrease mortality for severe CAP, early and close collaboration between emergency medicine and respiratory and critical care medicine teams is required. We propose a workflow incorporating these interventions.

Factors predicting in‐hospital mortality among patients admitted with community acquired pneumonia at a tertiary care hospital Karachi, Pakistan

“…It has been observed that early mortality in CAP (<48 hours after admission) is predominantly because of pneumonia related factors, such as septic shock, respiratory failure and multi‐organ failure . This may be of significance as the risk of clinical worsening is greatest in the first 24‐48 hours of admission, and any identified differences in risk patterns can be aggressively managed to reduce hospital mortality rates . In India the mortality rate because of lower respiratory infections is reported to be up to 20%, with high variability reported, as one study documented an overall mortality of 7.3% and ICU mortality of 45.3% .…”

“…8 This may be of significance as the risk of clinical worsening is greatest in the first 24-48 hours of admission, 9 and any identified differences in risk patterns can be aggressively managed to reduce hospital mortality rates. 10 In India the mortality rate because of lower respiratory infections is reported to be up to 20%, 11 with high variability reported, as one study documented an overall mortality of 7.3% and ICU mortality of 45.3%. 12 In Pakistan, limited research has been conducted on CAP and this existing literature mostly focuses on microbiological etiology and drug susceptibility patterns.…”

Activities of Daily Living (ADL) Predicts in-hospital Mortality in Geriatric Patients with Community-acquired Pneumonia (CAP)

“…Predicting the outcome and identifying potentially modi able risk factors for pneumonia in elderly patients is crucial in clinical decision making. Jason Phua [21] found that early and aggressive management measures, implemented and valuation of prognosis within 24 hours decrease mortality in severe CAP. Different prognostic scales have been documented to assess in CAP, the most commonly be used are the PSI and CURB-65.…”

Metabolomics in Sepsis and Its Impact on Public Health

“…Mortality rates among patients requiring admission to an ICU exceed 40% in multicenter cohort studies, and CAP complicated by sepsis is an emergency than needs to be timely recognized and treated [80]. Clinicians use severity assessment tools in order to stratify patients according to the severity of their disease.…”