Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organisation (MICRO), St James's Hospital, Dublin, Ireland.
Trinity College Dublin, Dublin, Ireland.
Intensive Care Med. 2023 Jun;49(6):615-632. doi: 10.1007/s00134-023-07033-8. Epub 2023 Apr 4.
Severe community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and whilst European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP.
The European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and Latin American Thoracic Association (ALAT) launched a task force to develop the first international guidelines for sCAP. The panel comprised a total of 18 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and treatment were chosen to be addressed. Systematic literature searches were performed in several databases. Meta-analyses were performed for evidence synthesis, whenever possible. The quality of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations.
Recommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions.
In these international guidelines, ERS, ESICM, ESCMID, and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment, and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made.
严重社区获得性肺炎（sCAP）与高发病率和死亡率相关，虽然有针对社区获得性肺炎的欧洲和非欧洲指南，但尚无针对 sCAP 的具体指南。
欧洲呼吸学会（ERS）、欧洲重症监护医学学会（ESICM）、欧洲临床微生物学和传染病学会（ESCMID）和拉丁美洲胸科协会（ALAT）发起了一个工作组，以制定首个国际 sCAP 指南。该小组由总共 18 名欧洲专家和 4 名非欧洲专家以及 2 名方法学家组成。选择了 8 个关于 sCAP 诊断和治疗的临床问题进行解决。在多个数据库中进行了系统文献检索。尽可能进行了荟萃分析以进行证据综合。使用 GRADE（推荐评估、制定与评价分级）评估证据质量。使用证据到决策框架来确定建议的方向和强度。
发布的建议与 sCAP 的诊断、抗生素、器官支持、生物标志物和辅助治疗有关。在考虑了效应估计的可信度、研究结果的重要性、治疗的理想和不良后果、成本、可行性、干预措施的可接受性以及对健康公平的影响后，对特定治疗干预措施提出了建议或反对意见。
在这些国际指南中，ERS、ESICM、ESCMID 和 ALAT 按照 GRADE 方法为 sCAP 的诊断、经验性治疗和抗生素治疗提供了基于证据的临床实践建议。此外，还强调了当前的知识差距，并提出了未来研究的建议。
