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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on May 4, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(3):87-91; doi:10.1093/bjaceaccp/mkp014
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Severe community-acquired pneumonia

J.B. Sadashivaiah, MBBS MD FRCA
Specialist Registrar
Department of Anaesthesia and Intensive Care
University Hospital of North Staffordshire
Newcastle Road
Stoke on Trent ST4 6QG
UK

B. Carr, MB ChB FRCA
Consultant in Intensive Care Medicine
Department of Anaesthesia and Intensive Care
University Hospital of North Staffordshire
Newcastle Road
Stoke on Trent ST4 6QG
UK
Tel: +44 1782 553580
Fax: +44 1782 552893
E-mail: bryan.carr@uhns.nhs.uk (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

Severe community-acquired pneumonia is associated with a very high mortality.
Streptococcus pneumoniae remains the most common aetiological agent.
Patients present with respiratory and systemic illness and typical radiological abnormalities.
Pneumonia severity index and CURB-65 scores are helpful in assessing illness severity.
Early identification of the high-risk patient and intensive goal-oriented therapy may reduce mortality.

 

Severe community-acquired pneumonia (CAP) is an increasingly common reason for admission to the intensive care unit (ICU).1 It is associated with significant morbidity, mortality, and utilization of health service resources. Inability to differentiate between CAP and non-pneumonic lower respiratory tract infections such as acute exacerbation of chronic obstructive pulmonary disease (COPD) has led to overtreatment, with a dramatic increase in the use of broad-spectrum antibiotics. This is associated with an increase in costs and side-effects, particularly Clostridium difficile-associated diarrhoea. A reduction in the frequency of Streptococcus pneumoniae infection has been associated with a . . . [Full Text of this Article]


   Definition
 

   Epidemiology
 

   Aetiology
 
Streptococcus pneumoniae

Legionella pneumophila

Staphylococcus aureus

Atypical pathogens


   Clinical features
 

   Investigations
 
General

Microbiology

Radiology

Severity assessment

Pneumonia severity index5

CURB-65 score6


   Management
 
Immediate ABCD approach

General

Respiratory

Antibiotic therapy


   Complications
 
Pulmonary

Other


   Role of vaccination
 
Influenza vaccine

Pneumococcal vaccine


   Recent advances: role of activated protein C
 

   Summary
 

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