Chest
Volume 103, Issue 1, January 1993, Pages 232-235
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Clinical Investigations in Critical Care
A Three-year Study of Severe Community-acquired Pneumonia With Emphasis on Outcome

https://doi.org/10.1378/chest.103.1.232Get rights and content

Fifty-eight consecutive patients with severe community-acquired pneumonia were studied prospectively during a three-year period. The group included 44 men and 14 women (mean age: 45.0 ± 15.7 years). The cause of pneumonia was diagnosed in 35 (60.3 percent) cases, and the most common pathogens were Streptococcus pneumoniae (37.1 percent), Legionella pneumophila (22.8 percent) and Gram-negative bacilli (11.4 percent). The fact that Mycobacterium tuberculosis was present in four (11.4 percent) patients and Pneumocystis carinii in three (8.5 percent) is worthy of note. The overall death rate was 22.4 percent. More than 50 percent of deaths occurred within the first five days and were caused by septic shock, hemoptysis (tuberculosis) or hypoxia. However, hypoxia remains the main fatal complication and all late-occurring deaths (>5 days) observed were due to this cause. These data could be important in planning strategies and protocols to improve prognosis.

Section snippets

Patients

We prospectively studied all the patients who had CAP admitted to the ICU at a 1,000-bed teaching hospital in Barcelona, Spain, from the beginning of 1988 until December of 1990. Community-acquired pneumonia was defined as an acute lower respiratory tract infection with onset before admission to the hospital plus the presence of pulmonary infiltrates on the chest radiograph compatible with acute pneumonia. Patients were admitted to the ICU either because they required mechanical ventilation or

RESULTS

We studied 58 consecutive patients (44 men and 14 women) who required hospitalization for SCAP in our ICU during a three-year period. The average age was 45.0 ± 15.7 years (range: 23 to 83 years). The most frequent underlying clinical conditioh was COPD (24 patients, 41.3 percent). On admission all patients had respiratory failure, five were mentally confused and six (10.3 percent) were in shock. Chest radiographs at admission showed unilateral involvement in 41 patients and bilateral in 17.

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Manuscript received May 21; revision accepted May 21.

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