Improvement in process of care and outcome in patients requiring intensive care unit admission for community acquired pneumonia

Abstract

BackgroundThe present study was performed to assess the prognosis of patients admitted to the intensive care unit (ICU) for community acquired pneumonia (CAP) after implementation of new processes of care.MethodsTwo groups of patients with CAP were admitted to a 16-bed multidisciplinary ICU in an urban teaching hospital during two different periods: the years 1995–2000, corresponding to the historical group; and 2005–2010, corresponding to the intervention group. New therapeutic procedures were implemented during the period 2005–2010. These procedures included a sepsis management bundle derived from the Surviving Sepsis Campaign, use of a third-generation cephalosporin and levofloxacin as the initial empirical antimicrobial regimen, and noninvasive mechanical ventilation following extubation.ResultsA total of 317 patients were studied: 142 (44.8%) during the historical period and 175 (55.2%) during the intervention period. Sequential Organ Failure Assessment scores were higher in patients in the intervention group (7.2 ± 3.7 vs 6.2 ± 2.8; p=0.008). Mortality changed significantly between the two studied periods, decreasing from 43.6% in the historical group to 30.9% in the intervention group (p < 0.02). A restrictive transfusion strategy, use of systematic postextubation noninvasive mechanical ventilation in patients with severe chronic respiratory or cardiac failure patients, less frequent use of dobutamine and/or epinephrine in patients with sepsis or septic shock, and delivery of a third-generation cephalosporin associated with levofloxacin as empirical antimicrobial therapy were independently associated with better outcomes.ConclusionPositive outcomes in ICU patients with CAP have significantly increased in our ICU in recent years. Many new interventions have contributed to this improvement.

Outcomes in patients with community-acquired pneumonia admitted to the intensive care unit

“…Other studies show diverging results in regard to the temporal outcomes of patients with severe CAP. Using a beforeafter design, Georges et al compared the outcomes of patients with severe CAP in the periods of 1995e2000 and 2005e2010 [2]. Processes of care in compliance with some of the 2004 Surviving Sepsis Guidelines recommendations [6] were implemented in their institution before the 2005e2010 period.…”

“…The generalizability of these findings is Figure 1 In-hospital mortality percentage and 95% confidence interval according to time period in patients with severe community-acquired pneumonia. limited because the study was carried out in a single center [2]. Using a large administrative database, Woodhead et al evaluated the outcomes of 17,869 patients with CAP that required ICU admission during the periods of 1995e1999 and 2000e2004.…”

Quels prélèvements aux urgences pour le diagnostic microbiologique d’une infection pulmonaire communautaire grave du sujet immunocompétent ?

“…La pneumonie communautaire grave (PCG) est la première cause de sepsis sévère et de choc septique rencontrée aux urgences [1]. Près de la moitié des patients présentant une PCG nécessite une hospitalisation en réanimation où la mortalité varie de 15 à 40 % selon les séries rapportées [2][3][4]. Les études épidémiologiques permettent d'actualiser régulièrement les agents microbiologiques responsables des PCG [5][6][7].…”

Mortality of CAP reduced in the UK: is this enough?

“…One study,10 which compared patients with CAP admitted to the intensive care unit in two periods (1995–2000 and 2005–2010), suggests that the decrease in mortality observed may be related to the follow-up of a sepsis management bundle derived from the Surviving Sepsis Campaign. In severe pneumococcal CAP, Gattarello et al 11 showed a decreased mortality with time.…”