title: Improvement in process of care and outcome in patients requiring intensive care unit admission for community acquired pneumonia.
abstract: BACKGROUND
  The present study was performed to assess the prognosis of patients admitted to the intensive care unit (ICU) for community acquired pneumonia (CAP) after implementation of new processes of care.
  
  
  METHODS
  Two groups of patients with CAP were admitted to a 16-bed multidisciplinary ICU in an urban teaching hospital during two different periods: the years 1995-2000, corresponding to the historical group; and 2005-2010, corresponding to the intervention group. New therapeutic procedures were implemented during the period 2005-2010. These procedures included a sepsis management bundle derived from the Surviving Sepsis Campaign, use of a third-generation cephalosporin and levofloxacin as the initial empirical antimicrobial regimen, and noninvasive mechanical ventilation following extubation.
  
  
  RESULTS
  A total of 317 patients were studied: 142 (44.8%) during the historical period and 175 (55.2%) during the intervention period. Sequential Organ Failure Assessment scores were higher in patients in the intervention group (7.2 ± 3.7 vs 6.2 ± 2.8; p=0.008). Mortality changed significantly between the two studied periods, decreasing from 43.6% in the historical group to 30.9% in the intervention group (p < 0.02). A restrictive transfusion strategy, use of systematic postextubation noninvasive mechanical ventilation in patients with severe chronic respiratory or cardiac failure patients, less frequent use of dobutamine and/or epinephrine in patients with sepsis or septic shock, and delivery of a third-generation cephalosporin associated with levofloxacin as empirical antimicrobial therapy were independently associated with better outcomes.
  
  
  CONCLUSIONS
  Positive outcomes in ICU patients with CAP have significantly increased in our ICU in recent years. Many new interventions have contributed to this improvement.
authors: Intensive Care Unit, Hôpital chatiliez, 135 rue du Président Coty, BP 619, 59208, Tourcoing, cedex, France. hgeorges@ch-tourcoing.fr
authors: Hugues
authors: H
authors: Georges
authors: Cécile
authors: C
authors: Journaux
authors: Patrick
authors: P
authors: Devos
authors: Serge
authors: S
authors: Alfandari
authors: Pierre Yves
authors: PY
authors: Delannoy
authors: Agnès
authors: A
authors: Meybeck
authors: Arnaud
authors: A
authors: Chiche
authors: Nicolas
authors: N
authors: Boussekey
authors: Olivier
authors: O
authors: Leroy
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
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