Severe community-acquired pneumonia: timely management measures in the first 24 hours

Phua, J. et al. Critical Care. Published online: 28 August 2016

Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.

In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.

These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools. The bundles include early guideline-concordant antibiotics including macrolides, early haemodynamic support (lactate measurement, intravenous fluids, and vasopressors), and early respiratory support (high-flow nasal cannulae, lung-protective ventilation, prone positioning, and neuromuscular blockade for acute respiratory distress syndrome).

CC flow chart

While the proposed interventions appear straightforward, multiple barriers to their implementation exist. To successfully decrease mortality for severe CAP, early and close collaboration between emergency medicine and respiratory and critical care medicine teams is required. We propose a workflow incorporating these interventions.

Read the full article here

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Quick guides: transforming urgent and emergency care services in England

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Image source: NHS England 

NHS England and partners have published a series of quick guides to support local health and care systems. The guides provide practical tips, case studies and links to useful documents, which can be used to implement solutions to commonly experienced issues. Use the information to manage upcoming winter pressures and plan for 2016 and beyond.

This guide has been produced by stakeholders [including hospital discharge teams; local authority adult services commissioners; continuing healthcare commissioners; independent care sector providers, including voluntary and housing sectors; patients; and carers] and provides:

• A checklist for local areas to use to identify areas for improvement;

• Information on existing solutions to common problems, including links to useful resources;

• A template policy and template patient letters to be adopted locally

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Other guides include:

Better use of care at home (PDF, 257kb) Clinical input to care homes (PDF, 208kb)
Identifying local care home placements (PDF, 971kb) Improving hospital discharge into the care sector (PDF, 201kb)
Technology in care homes (PDF, 213kb) Sharing patient information (PDF, 723kb)

More information available here