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.
Highlights
Community-acquired pneumonia (CAP) has plagued humankind for millennia
Hippocrates described pneumonia as a disease which the “ancients” named, and stated that “when pneumonia is at its height, the case is beyond remedy if he is not purged” [1]
For key studies on sepsis and respiratory failure which enrolled patients without severe CAP, we recorded the proportion of patients with pneumonia
Summary
Community-acquired pneumonia (CAP) has plagued humankind for millennia. Hippocrates described pneumonia as a disease which the “ancients” named, and stated that “when pneumonia is at its height, the case is beyond remedy if he is not purged” [1]. Calls have been made to treat CAP as an emergency, with aggressive interventions to lower mortality [13]. We will explore how early and aggressive management measures may result in decreased mortality in severe CAP. We focus on the impact of management measures implemented within the first 24 hours and carried out both in the emergency department (ED) and in the ICU. These measures comprise those which target severe CAP, such as identification and antibiotics, as well as those which target its complications, including septic shock and respiratory failure
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