Caracterización de la neumonía adquirida en la comunidad grave en la UCI. Estudio retrospectivo de 2 años

Abstract

Purpose: to describe the clinical characteristics and outcomes of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU), analyzing the patients’ profile, microbiology isolations and treatment received. Matherial and methods: a retrospective observational study was performed. Consecutive critically ill CAP patients receiving treatment a polivalent ICU were reviewed from january 1, 2018 to december 30, 2019. Main clinical characteristics, APACHE II, microbiological isolations, treatment, ICU stay and mortality were collected and analysed with SPSS 23 program. Results: A total of 41 consecutive eligible individuals were reviewed. The main reason for admission was acute respiratoriy failure in 87.8% of patients, followed by shock (need of vasoactive drugs). 14.6% required intubation as an initial respiratory support. Non invasive mechanical ventilation was initiated in 48.8% followed by high flow oxigenation in 26.8%. Finally, 48.8% of pacients required mechanical ventilation (20/41). The initial empiric treatment was a betalactamic and a macrolid or a quinolone in 78% of cases. In 51% there was an identifiable microbiological etiology. The isolation was S. Pneumoniae followed by Influenza virus. Global ICU mortality was 14,6%. Inmunosupression, need for vasoactive drugs and mechanical ventilation were related to higher mortality. Conclusions: The main reason for admission for severe community pneumonia was acute respiratory failure, requiring the use of invasive mechanical ventilation in half of the cases. The initial respiratory support with HFOT or NIMV did not present statistically significant differences of failure rate. The most frequent isolated germ in our sample was Streptococcus pneumoniae, followed by influenza virus. Mortality in severe community pneumonia was associated with the need for mechanical ventilation, vasoactive drugs, and the patient’s immune status.