Reduction of mortality in community-acquired pneumonia after implementing standardized care bundles in the emergency department

Hortmann, Marcus; Heppner, Hans-Jürgen; Popp, S.; Lad, Tanuj; Christ, Michael

doi:10.1097/mej.0000000000000106

Cited by 34 publications

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“…Georges et al [95] reported that a similar bundle including antibiotic therapy, fluids, and vasoactive agents was associated with a decrease in mortality from 43 % to 31 % in patients with severe CAP as defined by ICU admission in a single French centre. Hortmann et al [96] implemented a care bundle for all patients with CAP in a German ED. The bundle comprised checklists on history, clinical examination, investigations including lactate measurement and blood cultures, risk stratification according to CRB65, and treatment including antibiotic guidelines and fluid resuscitation.…”

Section: Methodsmentioning

confidence: 99%

Severe community-acquired pneumonia: timely management measures in the first 24 hours

et al. 2016

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Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools. The bundles include early guideline-concordant antibiotics including macrolides, early haemodynamic support (lactate measurement, intravenous fluids, and vasopressors), and early respiratory support (high-flow nasal cannulae, lung-protective ventilation, prone positioning, and neuromuscular blockade for acute respiratory distress syndrome).While the proposed interventions appear straightforward, multiple barriers to their implementation exist. To successfully decrease mortality for severe CAP, early and close collaboration between emergency medicine and respiratory and critical care medicine teams is required. We propose a workflow incorporating these interventions.

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Section: Methodsmentioning

confidence: 99%

Severe community-acquired pneumonia: timely management measures in the first 24 hours

et al. 2016

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“…40 On the other hand, studies have shown that timely management with an intervention bundle significantly improves outcomes of severe CAP. [41][42][43][44][45][46] Therefore, recognition and management of severe CAP as medical emergency has been advocated to improve patient prognosis. 32 What do these data imply for initial risk stratification?…”

Section: Identification Of High-risk Patients In the Ed: The Concept mentioning

confidence: 99%

Severity Assessment and the Immediate and Long-Term Prognosis in Community-Acquired Pneumonia

Kolditz

Braeken

Ewig

et al. 2016

Semin Respir Crit Care Med

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Severity assessment is a crucial step in the initial management of patients with community-acquired pneumonia (CAP). While approximately half of patients are at low risk of death and can be safely treated as outpatients, around 20% are at increased risk. While CURB-65 (confusion, respiratory rate, blood pressure, urea) and pneumonia severity index (PSI) scores are equally useful as an adjunct to clinical judgment to identify patients at low risk, the so-called minor American Thoracic Society/Infectious Diseases Society of America criteria are predictive of patients in need of intensified treatment (i.e., mechanical ventilation and/or vasopressor treatment). Such patients represent medical emergencies. In elderly patients, CRB-65 (confusion, respiratory rate, blood pressure, age) is no longer predictive of low risk; instead, poor functional status is the best predictor of death. In addition to scores, assessment of oxygenation and unstable comorbidity, as well as lactate and biomarkers remain important to consider. The added value of combined clinical and biomarker risk stratification strategies should be evaluated in large prospective interventional trials.Survivors of hospitalized CAP have a considerable excess long-term mortality. Risk factors include age, male gender, and nursing home residency, as well as increased PSI and CURB-65 scores. Cardiovascular, pulmonary, renal, and neoplastic comorbidities are prominent causes of long-term mortality. Comorbidities are vulnerable to both the acute and chronic subclinical inflammatory challenge delivered by pulmonary infection and are thereby drivers of mortality. Biomarkers are promising in identifying patients at increased risk of long-term mortality. Future studies should develop consistent strategies of risk stratification and intervention to improve long-term outcomes of patients with CAP.

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“…We have concluded that standardization of diagnostic and therapeutic processes in the ED is associated with improved outcome for patients hospitalized with CAP [1]. We have concluded that standardization of diagnostic and therapeutic processes in the ED is associated with improved outcome for patients hospitalized with CAP [1].…”

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confidence: 89%

Care bundles for community-acquired pneumonia in the emergency department

Hortmann

Lad²,

Christ³

2014

European Journal of Emergency Medicine

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Reduction of mortality in community-acquired pneumonia after implementing standardized care bundles in the emergency department

Abstract: This study demonstrated that implementation of standardized CAP care bundles in the ED is associated with a 21% relative risk reduction of in-hospital mortality. Standardization of diagnostic and therapeutic processes in the ED improves outcome of patients hospitalized for CAP.

Cited by 34 publications

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Severe community-acquired pneumonia: timely management measures in the first 24 hours

Severe community-acquired pneumonia: timely management measures in the first 24 hours

Severity Assessment and the Immediate and Long-Term Prognosis in Community-Acquired Pneumonia

Care bundles for community-acquired pneumonia in the emergency department

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