Community-acquired pneumonia in an intensive care unit
Pneumonia adquirida na comunidade numa unidade de cuidados intensivos
M. Raquel Marques1, António Nunes2, Cristina Sousa3, Fausto Moura2, João Gouveia2, Armindo Ramos4,5,
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1 Interna do internato Complementar de Medicina Interna/Resident, Internal Medicine
2 Assistente de Medicina Interna, Intensivista/Consultant, Internal Medicine, Intensive Care
3 Assistente Hospitalar Graduada de Gastrenterologia, Intensivista/Consultant, Gastroenterology Specialist, Intensive Care
4 Assistente Hospitalar Graduado de Medicina Interna, Intensivista e Director da Unidade de Cuidados Intensivos Médico-Cirúrgicos/Consultant, Internal Medicine Specialist, Intensive Care, Medical-Surgical Intensive Care Unit
5 Unidade de Cuidados Intensivos Médico-Cirúrgicos Hospital Pulido Valente
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"apellidos" => "Raquel Marques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "António" "apellidos" => "Nunes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Cristina" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Fausto" "apellidos" => "Moura" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "João" "apellidos" => "Gouveia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 5 => array:4 [ "nombre" => "Armindo" "apellidos" => "Ramos" "email" => array:1 [ 0 => "mraquelmarques@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Interna do internato Complementar de Medicina Interna/<span class="elsevierStyleItalic">Resident, Internal Medicine</span>" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Assistente de Medicina Interna, Intensivista/<span class="elsevierStyleItalic">Consultant, Internal Medicine, Intensive Care</span>" "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Assistente Hospitalar Graduada de Gastrenterologia, Intensivista/<span class="elsevierStyleItalic">Consultant, Gastroenterology Specialist, Intensive Care</span>" "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Assistente Hospitalar Graduado de Medicina Interna, Intensivista e Director da Unidade de Cuidados Intensivos Médico-Cirúrgicos/<span class="elsevierStyleItalic">Consultant, Internal Medicine Specialist, Intensive Care, Medical-Surgical Intensive Care Unit</span>" "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidade de Cuidados Intensivos Médico-Cirúrgicos Hospital Pulido Valente" "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Alameda das Linhas de Torres,117, 1769-001 Lisboa." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Pneumonia adquirida na comunidade numa unidade de cuidados intensivos" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-06-22" "fechaAceptado" => "2009-07-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec160672" "palabras" => array:3 [ 0 => "Community-acquired infections" 1 => "pneumonia" 2 => "critical care" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec160673" "palabras" => array:3 [ 0 => "Infecções adquiridas na comunidade" 1 => "pneumonia" 2 => "cuidados intensivos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Community-acquired pneumonia (CAP) is the leading cause of sepsis in adult critical care.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We present a retrospective study of patients admitted to a polyvalent intensive care unit with CAP from 1<span class="elsevierStyleSup">st</span> June 2004 – 31<span class="elsevierStyleSup">st</span> December 2006.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We analysed 76 patients with a mean age of 62.88 (18.75) years. Mean APACHE II score was 24.88 (9.75). Mean SAPS II was 51.18 (18.05), with a predicted mortality of 47.27%. Aetiology was identified in 42.1% of the patients. <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> was the most frequent aetiological agent, but the group of aetiological agents more frequently identified was Gram-negative enteric bacilli.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Levofloxacine was the most frequently previously used antibio tic. The most frequently used antibiotherapy scheme was the association ceftriaxone – azithromicine. It was possible to evaluate suitability of treatment in 32 patients; 27 were on suitable antibiotherapy regimes. 66 patients (86.8%) were on respirators, with a median length of 4 days. The median length of stay was 5.3 days. ICU mortality was 36.8% and hospital mortality 55.26%.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">SAPS II, CRP (C-reactive protein), potassium and initial unsuitable antibiotherapy were related to mortality. After multivariate analysis, only SAPS II maintained statistical significance.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Use of antibiotics should be judicious, taking the most frequent agents and their susceptibility into consideration.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A pneumonia adquirida na comunidade (PAC) é a principal causa de sépsis em cuidados intensivos de adultos. Com o objectivo de caracterizar o quadro clínico de PAC em cuidados intensivos, tratamento e avaliação de factores prognósticos, com especial relevância para a antibioterapia, realizou-se um estudo retrospectivo dos doentes admitidos numa UCI polivalente com PAC, de 1 de Junho de 2004 a 31 de Dezembro de 2006. Analisaram-se 76 doentes com uma idade média de 62,88 (18,75) anos. O APACHE II médio de 24,88 (9,75) e o SAPS 2 médio era de 51,18 (18,05), com mortalidade prevista de 47,27%. O microrganismo responsável foi identificado em 42,1% dos casos. O agente etiológico mais comum foi o <span class="elsevierStyleItalic">Streptococcus</span> pneumoniae, mas o grupo de agentes etiológicos mais frequentemente identificados foi o dos bacilos entéricos gramnegativos.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A antibioterapia prévia mais usada foi a levofloxacina. O esquema de antibioterapia mais usado na admissão foi a associação ceftriaxone com azitromicina. Em 32 doentes em que foi possível avaliar a adequação terapêutica, 27 estavam sob esquemas de antibioterapia adequados. Foram submetidos a ventilação mecânica 66 doentes (86,8%), com uma duração mediana de 4 dias. A demora mediana foi de 5,3 dias. A mortalidade na unidade foi de 36,8% e a hospitalar de 55,26%.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">O índice SAPS 2, o valor de PCR, o potássio sérico e a antibioterapia inicial não adequada relacionaram-se com maior mortalidade. Após análise multivariada, apenas o índice SAPS II manteve significado estatístico.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O uso da antibioterapia deve ser criterioso, tendo em conta os principais agentes e a sua susceptibilidade.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe community-acquired pneumonia as a cause of severe sepsis: Data from the PROWESS study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the PROWESS Clinical Evaluation Committee" "etal" => true "autores" => array:1 [ 0 => "P.F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 24 | 22 | 46 |
| 2024 September | 20 | 28 | 48 |
| 2024 August | 45 | 37 | 82 |
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| 2024 May | 19 | 32 | 51 |
| 2024 April | 20 | 31 | 51 |
| 2024 March | 23 | 25 | 48 |
| 2024 February | 17 | 27 | 44 |
| 2024 January | 17 | 21 | 38 |
| 2023 December | 11 | 23 | 34 |
| 2023 November | 14 | 28 | 42 |
| 2023 October | 18 | 30 | 48 |
| 2023 September | 16 | 33 | 49 |
| 2023 August | 11 | 20 | 31 |
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| 2023 April | 9 | 9 | 18 |
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