tailieunhanh - Báo cáo y học: "Severe community acquired pneumonia: what should we predict"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Severe community acquired pneumonia: what should we predict? | Available online http content 13 5 421 Letter Severe community acquired pneumonia what should we predict Bertrand Renaud and Aline Santin Department of Emergency Medicine Groupe Hospitalier Henri Mondor-Albert Chenevier AP-HP Université Paris 12 Faculte de Médecine Créteil F-94010 France Corresponding author Bertrand Renaud Published 15 October 2009 This article is online at http content 13 5 421 2009 BioMed Central Ltd Critical Care 2009 13 421 doi cc8111 Several aspects relating to the definition of severe community acquired pneumonia CAP and the design of prediction tools need to be addressed prior to further attempts to predict severe CAP. What is the concept of severe CAP based on CAP severity could be based on pathophysiological disorders that would allow physicians to objectively define severity. Alternatively CAP severity could be based on treatment intensity which would certainly facilitate its uptake and the development of clinical tools to assist physicians in decision-making. This second approach which seems more clinically relevant will be assumed for the rest of this letter. What are the most relevant criteria for severe CAP Basically there are two possibilities admission to ICU or respiratory circulatory support requirement 1 . The former criterion is often perceived as too vague as it remains a matter of individual judgment 2 . The second is less prone to subjectivity but may be too restrictive as intensive care benefit is not limited to patients that require vital support. However one must keep in mind the final objective of developing prediction tools for severe CAP in this context the definition exclusively based on respiratory hemodynamic support requirement is less restrictive. Therefore consistent with Chalmers 3 we suggest keeping this second definition of CAP severity. At this point several features regarding prediction of severe CAP may be considered. Given the increasing evidence