Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017

Abstract

Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.

Clinical practice guidelines for the management of community‐acquired pneumonia: A critical appraisal using the AGREE II instrument

“…Then, 88 out of 4125 references were identified for possible inclusion, after 23 duplicated were removed, 38 papers were excluded (Figure ). Accordingly, 18 publications met our inclusion criteria …”

“…About the 18 CPGs selected: there is an American guideline (IDSA), one is from Brazil, one from Italy (Gulf), one from India, two European (ERS and Multidisciplinary), two from Spain (SEPAR and Andalusian), a Peruvian guideline, a Dutch guideline (SWAB), two British guidelines (NICE and BTS), a Lebanese guideline, one from Latin America (Consensur), one Colombian guideline, one Chinese, one Korean and one Swedish …”

“…This reflects that the guidelines are clear in stating the objectives and the target population involved. Some guidelines had an special weaknesses in this area, usually because they do not establish properly the characteristics of the population or the expected results for the general application of the guideline. One of the criteria assess the use of specific objective for each one of the recommendations given; this is directly associated with the fact that they apply a PICO strategy or not; only the NICE and Korean guidelines used that strategy.…”

“…Despite having relevant professional groups, these guidelines do not describe the information of each author in detail as recommended. Similarly, it is important to describe the target users of the guidelines, many of them do not do it, such as Swedish, Andalusian, SEPAR, Brazilian and Indian …”

“…Accordingly, 18 publications met our inclusion criteria. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] As shown in Figure 1, the reason for exclusion were as follows:…”