title: Severe community-acquired pneumonia: timely management measures in the first 24 hours.
abstract: 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.
authors: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Jason
authors: J
authors: Phua
authors: Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Salt Lake City, UT, USA.
authors: Nathan C
authors: NC
authors: Dean
authors: Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China.|Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
authors: Qi
authors: Q
authors: Guo
authors: Department of Emergency Medicine, National University Hospital, National University Health System, Singapore, Singapore.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Win Sen
authors: WS
authors: Kuan
authors: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Hui Fang
authors: HF
authors: Lim
authors: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore. tow_keang_lim@nuhs.edu.sg.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. tow_keang_lim@nuhs.edu.sg.
authors: Tow Keang
authors: TK
authors: Lim
mesh_terms: D017714:Community-Acquired Infections / Q000401:mortality* / Q000628:therapy; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration; D017052:Hospital Mortality; D006801:Humans; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Care bundles; Emergency department; Intensive care unit; Resuscitation; Sepsis