{"id":23857,"date":"2023-04-27T04:00:00","date_gmt":"2023-04-26T20:00:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23857"},"modified":"2023-04-27T05:50:23","modified_gmt":"2023-04-26T21:50:23","slug":"intensive-care-med%e5%8f%91%e8%a1%a8%e6%8c%87%e5%8d%97%ef%bc%9aers-esicm-escmid-alat%e6%9c%89%e5%85%b3%e9%87%8d%e7%97%87%e7%a4%be%e5%8c%ba%e8%8e%b7%e5%be%97%e6%80%a7%e8%82%ba%e7%82%8e%e8%af%8a","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23857","title":{"rendered":"[Intensive Care Med\u53d1\u8868\u6307\u5357]\uff1aERS\/ESICM\/ESCMID\/ALAT\u6709\u5173\u91cd\u75c7\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e\u8bca\u7597\u6307\u5357"},"content":{"rendered":"\n<ul>\n<li>GUIDELINES<\/li>\n\n\n\n<li><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00134-023-07033-8#article-info\">Published:&nbsp;<time datetime=\"2023-04-04\">04 April 2023<\/time><\/a><\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\">ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of severe community-acquired pneumonia<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Ignacio Martin-Loeches,\u00a0Antoni Torres,\u00a0Blin Nagavci, et al<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><em>Intensive Care Med<\/em>\u00a0(2023). https:\/\/doi.org\/10.1007\/s00134-023-07033-8<\/h3>\n\n\n\n<h2 class=\"wp-block-heading\">Question 1: In patients with sCAP, should rapid microbiological techniques be added to current testing of blood and respiratory tract samples?<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendations<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">If the technology is available, we&nbsp;<strong>suggest<\/strong>&nbsp;sending a lower respiratory tract sample (either sputum or endotracheal aspirates) for multiplex PCR testing (virus and\/or bacterial detection) whenever non-standard sCAP antibiotics are prescribed or considered.<em>Conditional recommendation, very low quality of evidence<\/em>.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec101\">Question 2: In hypoxaemic patients with sCAP, can either non-invasive mechanical ventilation or high-flow nasal oxygen be used initially\u2014rather than supplemental standard oxygen administration\u2014to avoid intubation and reduce mortality?<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendations<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">In patients with sCAP and acute hypoxaemic respiratory failure not needing immediate intubation, we&nbsp;<strong>suggest<\/strong>&nbsp;using high-flow nasal oxygen (HFNO) instead of standard oxygen.<em>Conditional recommendation, very low quality of evidence<\/em>.<\/td><\/tr><tr><td colspan=\"2\">Non-invasive mechanical ventilation (NIV) might be an option in certain patients with persistent hypoxaemic respiratory failure not needing immediate intubation, irrespective of HFNO.<em>Conditional recommendation, low quality of evidence<\/em>.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec103\">Question 3: When using initial empirical therapy for sCAP, should a macrolide or fluoroquinolone be used as part of combination therapy, to reduce mortality and adverse clinical outcomes?<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendation<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">We&nbsp;<strong>suggest<\/strong>&nbsp;the addition of macrolides, not fluoroquinolones, to beta-lactams as empirical antibiotic therapy in hospitalised patients with sCAP.<em>Conditional recommendation, very low quality of evidence<\/em>.<\/td><\/tr><tr><td colspan=\"2\"><strong>Remark:<\/strong>&nbsp;The task force also considered the duration of treatment of macrolides being between 3 and 5&nbsp;days. This would be a reasonable timing especially in the context of de-escalation therapy.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec104\">Question 4: In patients with sCAP, can serum PCT be used to reduce the duration of antibiotic therapy and improve other outcomes in comparison to standard of care not guided by serial biomarker measurements?<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendation<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">We&nbsp;<strong>suggest<\/strong>&nbsp;the use of PCT to reduce the duration of antibiotic treatment in patients with sCAP.<em>Conditional recommendation, low quality of evidence<\/em>.<\/td><\/tr><tr><td colspan=\"2\"><strong>Remarks:<\/strong>&nbsp;The recommendation of using PCT must be considered together with clinical assessment with the aim of reducing antibiotic treatment duration. PCT might not be useful when clinical stability is achieved, and duration of antibiotic therapy is between 5 and 7&nbsp;days.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec105\">Question 5: Should oseltamivir be added to standard therapy in patients with sCAP and confirmed influenza?<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendation<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">We&nbsp;<strong>suggest<\/strong>&nbsp;the use of oseltamivir for patients with sCAP due to influenza confirmed by PCR.<em>Conditional recommendation, very low quality of evidence<\/em>.<\/td><\/tr><tr><td colspan=\"2\">When PCR is not available to confirm influenza, we&nbsp;<strong>suggest<\/strong>&nbsp;the use of empirical oseltamivir during the influenza season.<em>Conditional recommendation, very low quality of evidence<\/em>.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec106\">Question 6: Does the addition of steroids to antibiotic therapy in specific sCAP populations lead to better outcomes in comparison to when steroid therapy is not used?<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendation<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">In patients with sCAP, we&nbsp;<strong>suggest<\/strong>&nbsp;the use of corticosteroids if shock is present.<em>Conditional recommendation, low quality of evidence<\/em>.<\/td><\/tr><tr><td colspan=\"2\"><strong>Remarks:<\/strong>&nbsp;Based on common exclusion criteria from clinical trials, this recommendation does not apply to patients with viral sCAP (influenza, SARS, and MERS), uncontrolled diabetes and corticosteroid treatment for other reasons. When corticosteroid therapy is considered, methylprednisolone (0.5&nbsp;mg\u00b7kg<sup>\u22121<\/sup>&nbsp;every 12&nbsp;h for 5&nbsp;days) is a reasonable option.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec107\">Question 7: Does the use of a prediction score for drug-resistant pathogens lead to more appropriate therapy and improved outcomes (mortality, treatment failure, duration of antibiotic therapy, prolonged ICU stay)?<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendation<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">We&nbsp;<strong>suggest<\/strong>&nbsp;integrating specific risk factors (eventually computed into clinical scores) based on local epidemiology and previous colonisation to guide decisions regarding drug-resistant pathogens (excluding those immunocompromised) and empirical antibiotic prescription in sCAP patients.<em>Conditional recommendation, moderate quality of evidence<\/em>.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p> <\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec108\">Question 8: Do patients with sCAP and aspiration risk factors have better outcomes (mortality, length of stay, treatment failure) if treated with a risk-based therapy regimen instead of standard sCAP antibiotics?<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendation<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">In patients with sCAP and aspiration risk factors, we&nbsp;<strong>suggest<\/strong>&nbsp;standard CAP therapy regimen and not specific therapy targeting anaerobic bacteria.<em>Ungraded, good practice statement<\/em>.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/lw754\/springer-static\/image\/art%3A10.1007%2Fs00134-023-07033-8\/MediaObjects\/134_2023_7033_Tab1_HTML.png\" alt=\"\"\/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of  [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23857"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=23857"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23857\/revisions"}],"predecessor-version":[{"id":23859,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23857\/revisions\/23859"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=23857"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=23857"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=23857"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}