title: Severe pneumonia in intensive care:  cause, diagnosis, treatment and management:  a review of the literature.
abstract: OBJECTIVE
  Severe pneumonia is a common disease that intensive care physicians have to face. The review highlights recent findings about microbiology, diagnosis and treatment, including the management of critically ill patients with severe respiratory failure.
  
  
  RESULTS
  Epidemiological and clinical risk factors strongly influence microbiological cause in patients with severe pneumonia. In addition to typical respiratory pathogens, less common microrganisms and multidrug-resistant (MDR) germs may cause severe lung infections. New molecular diagnostic techniques appear promising for early detection of microbes involved in severe pneumonia. Antimicrobials remain the mainstay of causative severe pneumonia treatment and the optimization of antibiotic therapy may be obtained by applying their pharmacodynamic/pharmacokinetic properties. Several new strategies have been implemented for the management of acute respiratory failure (ARF) due to severe pneumonia; however, their extensive clinical application is limited by the need for well trained physicians and adequate hospital centers.
  
  
  CONCLUSIONS
  Despite advancements in antibiotic and life-supportive treatments, severe pneumonia remains a leading cause of intensive care unit (ICU) admission and death. Prompt and appropriate antimicrobial therapy is essential. The use of new nonconventional strategies for ARF management might be effective in more severe patients.
authors.affiliation: Istituto di Anestesiologia e Rianimazione, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: De Pascale
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bello
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003422:Critical Care; D006801:Humans; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy
chemical_list: D000890:Anti-Infective Agents