web analytics

Description

Aliberti et al evaluated patients with community-acquired pneumonia (CAP) requiring hospitalizaton who experienced clinical failure. These patients may benefit from more aggressive management. The authors are from the University of Milan, University of Louisville and Providence Hospital in Washington, DC.


 

Patient selection: community-acquired pneumonia requiring hospitalization

 

Outcome: clinical deterioration following admission

 

Criteria for clinical failure – one or more of the following:

(1) acute respiratory failure with need for mechanical ventilation (invasive or noninvasive)

(2) acute hemodynamic deterioration with need for fluid resuscitation (> 40 mL per kg), vasopressors or an invasive procedure (cardioversion, pericardial drainage, etc)

(3) in-hospital death within 28 days of admission

 

Clinical failure is not defined by severe pneumonia or sepsis on admission although these are risk factors for failure.

 

Clinical failure is termed early if it occurs <= 3 days after hospital admission.

It is termed late if it occurs > 3 days after hospital admission.

 

A patient who deteriorates needs to be evaluated for possible underlying causes. Conditions that may underly clinical failure include:

(1) sepsis or septic shock

(2) acute myocardial infarction

(3) progression of the pneumonia

(4) hospital-acquired pneumonia

(5) exacerbation of heart failure

 


To read more or access our algorithms and calculators, please log in or register.