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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Review

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

Authors: Jason Phua, Nathan C. Dean, Qi Guo, Win Sen Kuan, Hui Fang Lim, Tow Keang Lim

Published in: Critical Care | Issue 1/2016

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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.
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Metadata
Title
Severe community-acquired pneumonia: timely management measures in the first 24 hours
Authors
Jason Phua
Nathan C. Dean
Qi Guo
Win Sen Kuan
Hui Fang Lim
Tow Keang Lim
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1414-2

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Identification of regional overdistension, recruitment and cyclic alveolar collapse with electrical impedance tomography in an experimental ARDS model

Letter

Response to: influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation