Liapikou Adamantia, Rosales-Mayor Edmundo, Torres Antoni
6th Respiratory Department, Sotiria Hospital, Mesogion 152, 11527, Athens, Greece.
Expert Rev Respir Med. 2014 Jun;8(3):293-303. doi: 10.1586/17476348.2014.896202.
Severe CAP (SCAP), accounting for 6% of admissions to intensive care units (ICUs) needs early diagnosis and aggressive interventions at the most proximal point of disease presentation. The prognostic scores as the ATS/IDSA rule, the systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH or SCAP system are appropriate in early identification of eligible patients requiring admission to ICU. Then the recommended initial resuscitation in SCAP in the ICU consists of fluid volume intake titrated to specific goals after a fluid challenge and hemodynamic optimization. The first selection of antimicrobial therapy should be started in the first hour and would be broad enough to cover all likely pathogens. Combination therapy may be useful in patients with non refractory septic shock and severe sepsis pneumococcal bacteremia as well. After 6 hours the patient would be reevaluated in terms of hemodynamic stability and antibiotic and therapy. Future developments will focus on sepsis biomarkers, molecular diagnostic techniques and the development of novel therapeutic immunomodulaty agents.
重症社区获得性肺炎（SCAP）占重症监护病房（ICU）入院病例的6%，需要在疾病呈现的最早期阶段进行早期诊断和积极干预。诸如ATS/IDSA规则、收缩压、多叶浸润、白蛋白、呼吸频率、心动过速、意识模糊、血氧和pH值或SCAP系统等预后评分，对于早期识别需要入住ICU的合格患者是合适的。然后，ICU中SCAP的推荐初始复苏包括在液体冲击和血流动力学优化后，将液体摄入量滴定至特定目标。抗菌治疗的首选应在第一小时开始，且应足够广泛以覆盖所有可能的病原体。联合治疗对于非难治性感染性休克和严重脓毒症性肺炎球菌菌血症患者也可能有用。6小时后，将根据血流动力学稳定性以及抗生素和治疗情况对患者进行重新评估。未来的发展将集中在脓毒症生物标志物、分子诊断技术以及新型治疗性免疫调节药物的研发上。
