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This article is part of the supplement: Severe community-acquired pneumonia update: mortality, mechanisms and medical intervention

Highly Accessed Review

Demographics, guidelines, and clinical experience in severe community-acquired pneumonia

Jordi Rello

Author Affiliations

Critical Care Department, Joan XXIII University Hospital University Rovira i Virgili, Pere Virgili Health Institut, CIBER Enfermedades Respiratorias (CIBERES), Tarragona 43007, Spain

Critical Care 2008, 12(Suppl 6):S2  doi:10.1186/cc7025

Published: 26 November 2008

Abstract

Mortality in patients with community-acquired pneumonia (CAP) who require intubation or support with inotropes in an intensive care unit setting remains extremely high (up to 50%). Systematic use of objective severity-of-illness criteria, such as the Pneumonia Severity Index (PSI), British Thoracic Society CURB-65 (an acronym meaning Confusion, Urea, Respiratory rate, Blood pressure, age ≥65 years), or criteria developed by the Infectious Diseases Society of America/American Thoracic Society, to aid site-of-care decisions for pneumonia patients is emerging as a step forward in patient management. Experience with the Predisposition, Infection, Response, and Organ dysfunction (PIRO) score, which incorporates key signs and symptoms of sepsis and important CAP risk factors, may represent an improvement in staging severe CAP. In addition, it has been suggested that implementing a simple care bundle in the emergency department will improve management of CAP, using five evidence-based variables, with immediate pulse oxymetry and oxygen assessment as the cornerstone and initial step of treatment.