Abstract
BackgroundCommunity-acquired pneumonia (CAP) mortality exceeds 20 % in critical care patients despite appropriate antibiotic therapy. Regional tissue oxygen saturation index (rSO2) measured with near-infrared spectroscopy (NIRS) might facilitate early detection for patients at risk of serious complications. Our objectives were to determine the relationship between early determination of rSO2 and mortality and to compare discrimination power for mortality of rSO2 and other resuscitation variables in critically ill CAP patients.MethodsThis is a prospective observational study. Patients with CAP were enrolled within 6 h to intensive care admission. Demographics and clinical variables were recorded. rSO2 was determined using NIRS in brachioradialis muscle. All variables were determined at baseline and 24 h after admission.ResultsForty patients were enrolled. Fourteen patients (35 %) had a baseline rSO2 < 60 % and 7 of them died (50 %). Only 1 of 26 (3.8 %) patients with rSO2 ≥ 60 % died (p = 0.007). The area under ROC curve (AUROC) showed consistent mortality discrimination at baseline (0.84, p = 0.03) and at 24 h (0.86, p = 0.006) for rSO2 values. Cox regression analysis showed that “low” rSO2 at ICU admission (hazard ratio (HR) = 8.99; 95 % confidence interval (CI) 1.05–76.8; p = 0.045) and “low” rSO2 at 24 h (HR = 13.18; 95 % CI 1.52–113.6; p = 0.019) were variables independently associated with mortality. In contrast, other variables such as Acute Physiology and Chronic Health Evaluation (APACHE II) score (HR = 1.09; 95 % CI 0.99–1.19; p = 0.052) were not associated with mortality.ConclusionsOur findings suggest that forearm skeletal muscle rSO2 differs in patients with severe CAP according to outcome and might be an early prognosis tool.
Highlights
Community-acquired pneumonia (CAP) mortality exceeds 20 % in critical care patients despite appropriate antibiotic therapy
Prompt initiation of appropriate antibiotic therapy and adequate resuscitation are recommended as it potentially benefits patients’ prognosis [10, 11] the mortality rate in immunocompetent patients admitted to the intensive care unit (ICU) by CAP with appropriate antibiotic therapy exceeds 20 % [3] suggesting that antibiotics alone are not enough
Non-survivors had higher APACHE II score, greater need for invasive mechanical ventilation and higher frequency of septic shock compared to survivors
Summary
Community-acquired pneumonia (CAP) mortality exceeds 20 % in critical care patients despite appropriate antibiotic therapy. Community-acquired pneumonia (CAP) is an important cause of morbidity, mortality and increased health-care costs [1,2,3]. CAP is considered severe when admission to the intensive care unit (ICU) is needed due to respiratory distress or septic shock and occurs in about 9–16 % of hospitalized patients [4, 5]. Prompt initiation of appropriate antibiotic therapy and adequate resuscitation are recommended as it potentially benefits patients’ prognosis [10, 11] the mortality rate in immunocompetent patients admitted to the ICU by CAP with appropriate antibiotic therapy exceeds 20 % [3] suggesting that antibiotics alone are not enough. Microvascular dysfunction leads to reduced oxygen delivery and extraction, causing heterogeneous and deficient tissue oxygenation, which is associated with adverse clinical outcome
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