Improvement in process of care and outcome in patients requiring intensive care unit admission for community acquired pneumonia

BMC Infectious Diseases

Research Article

Patrick Devos¹  Cécile Journaux²  Pierre Yves Delannoy²  Arnaud Chiche²  Nicolas Boussekey²  Serge Alfandari²  Agnès Meybeck²  Olivier Leroy²  Hugues Georges³ 

[1] Department of Biostatistics, Centre Hospitalier Universitaire de Lille, 59000, Lille, France;Intensive Care Unit, Hôpital chatiliez, BP 619, 59208, 135 rue du Président Coty, Tourcoing, cedex, France;Intensive Care Unit, Hôpital chatiliez, BP 619, 59208, 135 rue du Président Coty, Tourcoing, cedex, France;Service de réanimation médicale, Hôpital chatiliez, BP 619, 59208, 135 rue du Président Coty, Tourcoing, cedex, France;

关键词: Severe community acquired pneumonia;    Intensive care unit;    Antimicrobial therapy;    Combination therapy;   

DOI  :  10.1186/1471-2334-13-196

 received in 2012-11-20, accepted in 2013-04-24,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsTwo 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.ResultsA 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.ConclusionPositive outcomes in ICU patients with CAP have significantly increased in our ICU in recent years. Many new interventions have contributed to this improvement.

【 授权许可】

CC BY   
© Georges et al.; licensee BioMed Central Ltd. 2013