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Vol. 41. Issue 1.
Pages 20-26 (January 2005)
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Vol. 41. Issue 1.
Pages 20-26 (January 2005)
Original Articles
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Clinical Picture and Prognostic Factors for Severe Community-Acquired Pneumonia in Adults Admitted to the Intensive Care Unit
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A. Díaza, M. álvareza, C. Callejasb, R. Rossob, K. Schnettlerb, F. Saldíasa,
Corresponding author
alediazf@hotmail.com

Correspondence: Dr. A. Díaz Fuenzalida. Departamento de Enfermedades Respiratorias. Pontificia Universidad Católica de Chile. Marcoleta, 345, 4.°. Santiago de Chile. Chile
a Departamento de Enfermedades Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
b Seventh-year medical students, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
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Objective

In Chile very little information is available on severe community-acquired pneumonia treated in intensive care units. This study describes the clinical picture, prognostic factors, and treatment of adult patients admitted to the intensive care unit for severe community-acquired pneumonia.

Patients and methods

A total of 113 consecutive patients were included in this prospective, descriptive study.

Results

The mean (SD) age of the 113 patients was 73 (15). Of these, 95% had associated comorbidity, and 81% were in the high-risk classes of the Pneumonia Severity Index. Etiology was identified in 31%, and the most common pathogens were Streptococcus pneumoniae (40%), gram negative bacilli (17%), and Mycoplasma pneumoniae (6%). The main complications were the need for mechanical ventilation (45%), septic shock (26%), heart failure (24%), and arrhythmias (15%). Mortality at 30 days was 16.8%, and multivariate analysis revealed the following factors to be associated with a greater risk of death: acute renal failure (odds ratio: 5.1), and glycemia above 300 mg/dL (odds ratio: 7.2).

Conclusions

The patients with severe pneumonia admitted to the intensive care unit are elderly, with a high level of comorbidity and complications, but most survive.

Cuadro clínico y factores pronósticos de la neumonía adquirida en la comunidad grave en adultos hospitalizados en la unidad de cuidados intensivos

Key Words:
Pneumonia
Community
Severe
Intensive care
Prognosis
Risk
Objetivo

En Chile existe escasa información acerca de la neumonía adquirida en la comunidad de carácter grave ma-nejada en las unidades de cuidados intensivos. En este tra-bajo se describen el cuadro clínico, los factores pronósticos y el tratamiento de pacientes adultos hospitalizados en la unidad de cuidados intensivos por neumonía adquirida en la comunidad grave.

Pacientes Y Métodos

Se ha realizado un estudio clínico prospectivo y descriptivo que ha incluido a 113 pacientes consecutivos.

Resultados

De los 113 pacientes incluidos (edad media ± desviación estándar: 73 ± 15 años), el 95% tenía comorbili-dad asociada y un 81% pertenecía a las categorías de alto riesgo del índice de gravedad de la neumonía (Pneumonia Severity Index). Se demostró la etiología en el 31% y los pa-tógenos más frecuentes fueron Streptococcus pneumoniae (40%), bacilos gramnegativos (17%) y Mycoplasma pneumoniae (6%). Las principales complicaciones fueron necesidad de ventilación mecánica (45%), shock séptico (26%), insuficiencia cardíaca (24%) y arritmias (15%). La mortalidad a los 30 días fue del 16,8% y mediante un análisis multivaria-do se identificaron los siguientes factores asociados a mayor riesgo de muerte: insuficiencia renal aguda (odds ratio = 5,1) y glucemia mayor de 300 mg/dl (odds ratio = 7,2).

Conclusiones

Los pacientes con neumonía grave ingresados en la unidad de cuidados intensivos son de edad avan-zada, con una alta tasa de comorbilidad y complicaciones, pero la mayoría sobrevive.

Palabras clave:
Neumonía
Comunidad
Grave
Cuidados intensivos
Pronóstico
Riesgo
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Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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