Chest
Clinical Investigations in Critical CareAssessment of Prognosis in Patients With Community-Acquired Pneumonia Who Require Mechanical Ventilation
Section snippets
Patient Selection
We reviewed chart data from 144 consecutive admissions of adult patients with severe CAP requiring mechanical ventilation. The study was approved by our institution's committee on human research. The patients were admitted to the ICU of Moffitt-Long Hospital between July 1994 and July 1997. Nine patients were excluded because of misplaced records. The main outcome measure was hospital mortality. Thirty-five predictive variables and antibiotic use, assessed over the first 24 h of mechanical
Subject Characteristics
The study population consisted of 144 patients; overall hospital mortality was 46% (n = 66). All data were obtained during the first 24 h of mechanical ventilation, except where noted. Table 1, Table 2 show baseline characteristics of the study population. An etiologic organism was identified in 30% of patients, with Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus being the most common isolates (Table 3). Table 4 details antibiotic use at the start of mechanical
Discussion
We have found that the extent of lung injury as well as other nonpulmonary factors are important independent markers of prognosis in patients with CAP requiring mechanical ventilation. These predictors were incorporated into a model that shows good discriminative ability (88% accuracy in outcome classification) in our study. Furthermore, the model identified patients with the poorest prognosis (> 95% probability of death in hospital) without misclassifying survivors. Importantly, the model
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Cited by (50)
Elderly patients and intensive care: Systematic review and geriatrician's point of view
2017, Journal Europeen des Urgences et de ReanimationElderly patients and intensive care: Systematic review and geriatrician's point of view
2017, Revue de Medecine InterneEvolution over a 15-year period of the clinical characteristics and outcomes of critically ill patients with severe community-acquired pneumonia
2016, Medicina IntensivaCitation Excerpt :Morbidity and mortality in patients remain high, despite advances in critical care management and antimicrobial therapy. Mortality in those admitted in to the intensive care unit (ICU), ranges from 21% to 58%.5–7 Early empiric antimicrobial therapy has proven the most effective approach to decreasing mortality in patients with SCAP.
Severe Community-Acquired Pneumonia
2013, Critical Care ClinicsCitation Excerpt :Of those admitted to the ICU, 44% to 83% of patients require mechanical ventilation at the time of admission14–19 and up to 50% present with concomitant septic shock.20 Mortality rates are high, ranging from 11% to 56%.11,21–26 Although the definition of severe pneumonia remains somewhat subjective and imprecise de facto respiratory and/or circulatory failure often define this entity.
Severe Community-Acquired Pneumonia
2009, Infectious Disease Clinics of North AmericaEarly evolution of arterial oxygenation in severe community-acquired pneumonia: A prospective observational study
2007, Journal of Critical CareCitation Excerpt :The patient selection avoided the mixed population of ventilated and nonventilated patients. Similar to a recent study by Pascual et al [12], the evolution of arterial oxygenation was demonstrated to be an important prognostic variable. One difference of note between these 2 studies was the duration of data collection, which was 48 hours of ventilatory support in this study but only 24 hours in their study.
Supported by the UCSF Department of Medicine and NIH grant HL51856.