Management of pneumonia in critically ill patients

Cillóniz, Catia; Torres, Antoni; Niederman, Michael S.

doi:10.1136/bmj-2021-065871

Cited by 62 publications

(54 citation statements)

References 284 publications

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“…Pneumonia is an inflammation of lung tissue (fine bronchial, alveolar, and interstitial), caused by different etiologies and different pathogenic bacteria in different settings with similar or identical pathophysiological processes, all of which can deteriorate and worsen into SP when they develop into certain disease stages, causing multiorgan dysfunction or even being life-threatening, with a mortality rate of up to 30%–50% [ 9 ]. SP is prone to a variety of comorbidities and increases the financial burden of healthcare.…”

Section: Discussionmentioning

confidence: 99%

Effect Observation of Optimized Individualized Nursing Care Applied to ICU Patients with Severe Pneumonia

Wang

Yi-mei

et al. 2022

Emergency Medicine International

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Purpose. This study aims to observe the effect of optimized individualized nursing care applied to intensive care unit (ICU) patients with severe pneumonia (SP). Methods. 440 patients with SP admitted to the ICU of our hospital from January 2019 to June 2020 were provided with routine nursing care (group A), and 550 patients with SP admitted from July 2020 to December 2021 were provided with optimized individualized nursing care (group B). The blood lactate index and acute physiology and chronic health evaluation (APACHE II) scores before and after care were compared between the two groups. The WBC count recovery time, mechanical ventilation time, antipyretic time, and length of hospital stay of the two groups were recorded. The complication rate of the two groups during the nursing care period was compared. The prognosis effect of the two groups after 6 and 12 months of discharge was followed up with the Seattle angina pectoris questionnaire (SAQ). Results. After care, the lactate level and lactate clearance rate were higher in both groups than before care, and the lactate level in group B was lower than that in group A and the lactate clearance rate was higher than that in group A ( P < 0.05 ). After care, APACHE II scores were lower in both groups than before care, and lower in group B than in group A ( P < 0.05 ). After care, the WBC count recovery time, mechanical ventilation time, antipyretic time, and length of hospital stay were shorter in group B than in group A ( P < 0.05 ). During the nursing care period, the complication rate was lower in group B (5.82%) than in group A (11.59%) ( P < 0.05 ). 6 and 12 months after discharge, the SAQ scores were higher in group B than in group A ( P < 0.05 ). Conclusion. Optimized individualized nursing care applied to ICU SP patients can effectively improve the patients’ physiological indicators, reduce complications, improve the prognosis of quality of life, and have a positive effect on the patients’ speedy recovery.

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Section: Discussionmentioning

confidence: 99%

Effect Observation of Optimized Individualized Nursing Care Applied to ICU Patients with Severe Pneumonia

Wang

Yi-mei

et al. 2022

Emergency Medicine International

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“…Virus replication in the lower respiratory tract may be detectable for longer periods than in the upper respiratory tract and nasopharyngeal swabs can give false negatives. Two review articles provided general overviews of the microbiologic diagnosis of pneumonia, including important data about microbiologic diagnostic testing for respiratory viruses that cause pneumonia [116,117]. A recent review by COLAGROSSI et al [118] provided an overview of the rapid microbiologic detection of the main respiratory viruses.…”

Section: Microbiologic Diagnosismentioning

confidence: 99%

Respiratory viruses: their importance and lessons learned from COVID-19

et al. 2022

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Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities,i.e.obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses.

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“…The intensive care unit (ICU) patients are exposed to pneumonia, sepsis, and other inflammation (1,2), which hampers the treatment and leads to high mortality rates ranging from 11% to 18% (3,4). Survivors may suffer from chronic and life-changing physical, psychosocial, and cognitive sequelae (5,6).…”

Section: Introductionmentioning

confidence: 99%

Association of longitudinal platelet count trajectory with ICU mortality: A multi-cohort study

et al. 2022

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ObjectivePlatelet (PLT) engages in immune and inflammatory responses, all of which are related to the prognosis of critically ill patients. Although thrombocytopenia at ICU admission contributes to in-hospital mortality, PLT is repeatedly measured during ICU hospitalization and the role of longitudinal PLT trajectory remains unclear. We aimed to identify dynamic PLT trajectory patterns and evaluate their relationships with mortality risk and thrombocytopenia.MethodsWe adopted a three-phase, multi-cohort study strategy. Firstly, longitudinal PLT trajectory patterns within the first four ICU days and their associations with 28-day survival were tested in the eICU Collaborative Research Database (eICU-CRD) and independently validated in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Secondly, the relationships among PLT trajectory patterns, thrombocytopenia, and 28-day mortality were explored and validated. Finally, a Mortality GRade system for ICU dynamically monitoring patients (Mortality-GRID) was developed to quantify the mortality risk based on longitudinal PLT, which was further validated in the Molecular Epidemiology of Acute Respiratory Distress Syndrome (MEARDS) cohort.ResultsA total of 35,332 ICU patients were included from three cohorts. Trajectory analysis clustered patients into ascending (AS), stable (ST), or descending (DS) PLT patterns. DS patients with high baseline PLT decline quickly, resulting in poor prognosis. AS patients have low baseline PLT but recover quickly, favoring a better prognosis. ST patients maintain low PLT, having a moderate prognosis in between (HRSTvsAS = 1.26, 95% CI: 1.14–1.38, P = 6.15 × 10−6; HRDSvsAS = 1.58, 95% CI: 1.40–1.79, P = 1.41 × 10−13). The associations remained significant in patients without thrombocytopenia during the entire ICU hospitalization and were robust in sensitivity analyses and stratification analyses. Further, the trajectory pattern was a warning sign of thrombocytopenia, which mediated 27.2% of the effects of the PLT trajectory on 28-day mortality (HRindirect = 1.11, 95% CI: 1.06–1.17, P = 9.80 × 10−6). Mortality-GRID well predicts mortality risk, which is in high consistency with that directly estimated in MEARDS (r = 0.98, P = 1.30 × 10−23).ConclusionLongitudinal PLT trajectory is a complementary predictor to baseline PLT for patient survival, even in patients without risk of thrombocytopenia. Mortality-GRID could identify patients at high mortality risk.

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Management of pneumonia in critically ill patients

Cited by 62 publications

References 284 publications

Effect Observation of Optimized Individualized Nursing Care Applied to ICU Patients with Severe Pneumonia

Effect Observation of Optimized Individualized Nursing Care Applied to ICU Patients with Severe Pneumonia

Respiratory viruses: their importance and lessons learned from COVID-19

Association of longitudinal platelet count trajectory with ICU mortality: A multi-cohort study

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