Severe Pneumonia in Intensive Care
Severe Pneumonia in Intensive Care
Purpose of review Severe pneumonia is a common disease that intensive care physicians have to face. The review highlights recent findings about microbiology, diagnosis and treatment, including the management of critically ill patients with severe respiratory failure.
Recent findings Epidemiological and clinical risk factors strongly influence microbiological cause in patients with severe pneumonia. In addition to typical respiratory pathogens, less common microrganisms and multidrug-resistant (MDR) germs may cause severe lung infections. New molecular diagnostic techniques appear promising for early detection of microbes involved in severe pneumonia. Antimicrobials remain the mainstay of causative severe pneumonia treatment and the optimization of antibiotic therapy may be obtained by applying their pharmacodynamic/pharmacokinetic properties. Several new strategies have been implemented for the management of acute respiratory failure (ARF) due to severe pneumonia; however, their extensive clinical application is limited by the need for well trained physicians and adequate hospital centers.
Summary Despite advancements in antibiotic and life-supportive treatments, severe pneumonia remains a leading cause of intensive care unit (ICU) admission and death. Prompt and appropriate antimicrobial therapy is essential. The use of new nonconventional strategies for ARF management might be effective in more severe patients.
Severe pneumonia in intensive care unit (ICU) patients represents a major concern for physicians because of the high mortality and morbidity rate attributable to these episodes. During past decades many strategies have been implemented with the aim to optimize the outcome of patients with severe lung infections, and part of these efforts is focused upon the need to best define and predict illness severity. Additionally to some other available clinical scores, the last Infectious Diseases Society of America/American Thoracic Society(IDSA/ATS) guidelines have assessed major and minor criteria that seem to best define the severity of community-acquired pneumonia (CAP) and decide the need for ICU admission. It is note worthy that these scores were created for severe CAP (SCAP) and their application to the other severe pneumonia categories may be only extrapolated. Furthermore it might be difficult to discriminate whether a pneumonia is really community-acquired (CAP) or has been developing in a patient who was exposed to the healthcare environment [healthcare-associated pneumonia (HCAP)] or has been acquired in the hospital setting [hospital-acquired pneumonia (HAP)]. Critically ill patients, already admitted to ICU, may subsequently develop severe pneumonia [ventilator-associated pneumonia (VAP); nonventilator ICU-acquired pneumonia(NV-ICUAP)]. Both community-acquired or nosocomial pneumonia can progress to acute respiratory distress syndrome (ARDS) and acute lung injury(ALI), which are associated with a mortality rate of more than 50%.
The aim of this study is to review the current knowledge about ICU patients affected by severe pneumonia, with regards to microbiological, diagnostic, therapeutic and management aspects.
Abstract and Introduction
Abstract
Purpose of review Severe pneumonia is a common disease that intensive care physicians have to face. The review highlights recent findings about microbiology, diagnosis and treatment, including the management of critically ill patients with severe respiratory failure.
Recent findings Epidemiological and clinical risk factors strongly influence microbiological cause in patients with severe pneumonia. In addition to typical respiratory pathogens, less common microrganisms and multidrug-resistant (MDR) germs may cause severe lung infections. New molecular diagnostic techniques appear promising for early detection of microbes involved in severe pneumonia. Antimicrobials remain the mainstay of causative severe pneumonia treatment and the optimization of antibiotic therapy may be obtained by applying their pharmacodynamic/pharmacokinetic properties. Several new strategies have been implemented for the management of acute respiratory failure (ARF) due to severe pneumonia; however, their extensive clinical application is limited by the need for well trained physicians and adequate hospital centers.
Summary Despite advancements in antibiotic and life-supportive treatments, severe pneumonia remains a leading cause of intensive care unit (ICU) admission and death. Prompt and appropriate antimicrobial therapy is essential. The use of new nonconventional strategies for ARF management might be effective in more severe patients.
Introduction
Severe pneumonia in intensive care unit (ICU) patients represents a major concern for physicians because of the high mortality and morbidity rate attributable to these episodes. During past decades many strategies have been implemented with the aim to optimize the outcome of patients with severe lung infections, and part of these efforts is focused upon the need to best define and predict illness severity. Additionally to some other available clinical scores, the last Infectious Diseases Society of America/American Thoracic Society(IDSA/ATS) guidelines have assessed major and minor criteria that seem to best define the severity of community-acquired pneumonia (CAP) and decide the need for ICU admission. It is note worthy that these scores were created for severe CAP (SCAP) and their application to the other severe pneumonia categories may be only extrapolated. Furthermore it might be difficult to discriminate whether a pneumonia is really community-acquired (CAP) or has been developing in a patient who was exposed to the healthcare environment [healthcare-associated pneumonia (HCAP)] or has been acquired in the hospital setting [hospital-acquired pneumonia (HAP)]. Critically ill patients, already admitted to ICU, may subsequently develop severe pneumonia [ventilator-associated pneumonia (VAP); nonventilator ICU-acquired pneumonia(NV-ICUAP)]. Both community-acquired or nosocomial pneumonia can progress to acute respiratory distress syndrome (ARDS) and acute lung injury(ALI), which are associated with a mortality rate of more than 50%.
The aim of this study is to review the current knowledge about ICU patients affected by severe pneumonia, with regards to microbiological, diagnostic, therapeutic and management aspects.
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