Pneumonia severity assessment

Several scoring systems are available for assessing the severity of the pneumonia the Pneumonia Severity Index (PSI), Confusion, Urea, Respiratory Rate, and Blood Pressure (CURB), and CURB-65 (those 65 years and older).9,24 Some... 

Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001 163 1730-1754. 

The BTS endorses a severity assessment model for community-acquired pneumonia which allows patients to be stratified into groups at specific risk of mortality and therefore suitable for different clinical management pathways. A validated six-point scoring system was proposed with one point for each of confusion urea >7 mmol/L respiratory rate >30/min blood pressure low (systolic <90 mmHg or diastolic <60 mmHg) and age >65 years. This is known... 

The signs and symptoms and severity of pneumonia are needed not only to diagnose the patient but also to assess response to therapy. 

Assess the patient s symptoms and status (i.e., inpatient, outpatient, or intubated) to determine the type of pneumonia and comorbid conditions. Does the patient have moderate to severe asthma, COPD, or emphysema or is a current smoker ... 

Neutropenia occurs when the percent of mature neutrophils plus the percent of bands (or immature neutrophils) times the WBC count is less than 500/mm3 (0.5 x 109/L). The risk of infection increases as the extent of neutropenia becomes severe and the duration increases. The assessment of infection is different in the neutropenic cancer patient. First, WBC counts may be profoundly low, so no left shift is available to evaluate. Second, there is no pus without WBCs. Some bacterial pneumonias may not be readily apparent by chest x-ray. Third, if patients are receiving steroids as part of the cancer treatment, fever curves may be blunted or absent. When a patient does have a fever and is neutropenic, prompt initiation of anti-infectives is necessary. 

Index functional status 30 d after stroke. The results showed that only the severity of neurological deficit predicted greater 30-d mortality in these patients. Patients with hyperthermia on the first day of hospitalization had increased mortality and worse functional status at 30 d, but increased temperature was not an independent predictor of mortality 30 d after PICH. In a study to assess typical early onset complications following ischemic stroke, Weimar et al. (5) looked at a cohort of 3866 patients from 14 neurology departments with an acute stroke unit. In the first week following admission, increased intracranial pressure (ICP) and recurrent cerebral ischemia were the most frequent complications, along with fever, severe hypertension, and pneumonia. Similar concerns are also found in cardiac surgery patients in whom perioperative stroke occurred (6). 

How is the diagnosis of pneumonia made and how is the severity of illness assessed ... 

Immunosuppressed radiation victims may also be at risk for reactivation of cytomegalovirus (CMV) and Pneumocystis carinii pneumonia. In a limited casualty situation, if resources are available, clinicians should obtain CMV serology. In addition, patients should have a sensitive assay (antigen assessment or polymerase chain reaction test) every 2 weeks for 30 days postexposure, while those with documented previous CMV exposure should have the assay repeated until 100 days postexposure (2). Patients developing lymphopenia should have a CD4 cell count considered at 30 days postexposure. Those with a CD4 count below 0.2000 x 10 cells L" are at risk for Pneumocystis carinii pneumonia. Physicians should withhold trimethoprim-suha prophylaxis until the leukocyte count is above 3.0 x 10 cells L" or until the absolute neutrophil count is above 1.5 x 10 cells L . Atovaquone, dap-sone and aerosohzed pentamidine are alternative prophylactic agents. Patients should continue prophylactic treatment until the CD4 count reaches or exceeds 0.2000 X 10 cells L, which may occur over several months (2). 

Campbell GD, Niederman MS, Broughton WA, et al. Official ATS statement Hospital-acquired pneumonia in adults Diagnosis, assessment of severity, initial antimicrobial therapy and preventative strategies. Am J Respir Crit Care Med 1995 153 1711-1725. 

Anti-Inflammatory Therapeutics. The Streptococcus pneumoniae pulmonary host resistance assay is recommended for anti-inflammatory therapeutics (Komocsar et al., 2007). The Streptococcus pneumoniae pulmonary host resistance model in Lewis rats was used to assess the effects of anti-inflammatory agents on innate immunity. The model was able to predict potential drug suppression of the innate immune response to Streptococcus pneumoniae. The authors stated the ability to rank order the severity of innate immune suppression with multiple test articles in the same study made this model effective in screening potential drug candidates. 

A Assessment Ventilatory failure has multiple causes, including failure of the ventilatory muscles, central depression of respiratory drive, and severe pneumonia or pulmonary edema. Examples of drugs and toxins that cause ventilatory failure and the causative mechanisms are listed in Table 1-1. 

Cardiovascular A 17-year-old man with a 3-year history of ulcer symptoms, diarrhea, and bouts of abdominal colic developed severe hypotension (50/20 mmHg) after receiving intravenous metoclopramide for acute vomiting with diarrhea [9 ]. He then developed pneumonia, rhabdomyolysis, renal tubular necrosis, and disseminated intravascular coagulation. A diagnosis of gastrinoma was made. During hormonal assessment, he received a second dose of... 

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