ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 3 (2021), MANAGEMENT OF COMMUNITY — ACQUIRED PNEUMONIA
No. 3 (2021)
MANAGEMENT OF COMMUNITY — ACQUIRED PNEUMONIA

Modern approaches to the diagnostics, treatment and prevention of severe community-acquired pneumonia in adults: a review

Published 26.10.2021
S.N. Avdeev
Sechenov First Moscow State Medical University, Moscow, Russia
https://orcid.org/0000-0002-5999-2150
Boris Z. Belotserkovskiy
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia; St. Alexiy’s Hospital, Moscow, Russia
https://orcid.org/0000-0002-5758-5703
A.V. Dehnich
Smolensk State Medical University, Smolensk, Russia
https://orcid.org/0000-0001-6897-5486
A.A. Zaytsev
Main Military N.N. Burdenko`s Clinical Hospital, Moscow, Russia
https://orcid.org/0000-0002-0934-7313
R.S. Kozlov
Smolensk State Medical University, Smolensk, Russia
https://orcid.org/0000-0001-8728-1113
D.N. Protsenko
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia; City Clinical Hospital No. 40, Moscow, Russia
https://orcid.org/0000-0002-5166-3280
S.A. Ratchina
Sechenov First Moscow State Medical University, Moscow, Russia
https://orcid.org/0000-0002-3329-7846
A.I. Sinopalnikov
Russian Medical Academy of Continuous Professional Education, Moscow, Russia
https://orcid.org/0000-0002-1990-2042
S.V. Yakovlev
Sechenov First Moscow State Medical University, Moscow, Russia; City S.S. Yudin`s Clinical Hospital, Moscow, Russia
https://orcid.org/0000-0001-7606-8608
A.I. Yaroshetskiy
Sechenov First Moscow State Medical University, Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-1484-092X
#2021-3
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Keywords

community-acquired infections
pneumonia
anti-bacterial agents
respiratory therapy

How to Cite

1.
Avdeev S.N., Belotserkovskiy B.Z., Dehnich A.V., Zaytsev A.A., Kozlov R.S., Protsenko D.N., Ratchina S.A., Sinopalnikov A.I., Yakovlev S.V., Yaroshetskiy A.I. Modern approaches to the diagnostics, treatment and prevention of severe community-acquired pneumonia in adults: a review. Annals of Critical Care. 2021;(3):27-46. doi:10.21320/1818-474X-2021-3-27-46
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Abstract

The article provides an overview of literature on severe community-acquired pneumonia (CAP) and the most recent data on the epidemiology and etiology of CAP, and describes the antibiotic susceptibility of Streptococcus pneumoniae — the leading causative agent of CAP. The article discusses demonstrative diagnostic data and emphasizes the need to determine as early as possible the oxygen saturation of arterial blood using a pulse oximeter, as well as to dynamically measure the concentration of inflammatory markers in blood and carry out a comprehensive microbiological examination. The authors argue for the advantages of computed tomography over conventional x-ray examination and point out the usefulness of ultrasound to diagnose and dynamically assess the condition of lung tissue in the course of treatment. The article also provides up-to-date recommendations for the differential antibiotic treatment of severe CAP patients based on the existence of risk factors making them susceptible to the infection with certain microorganisms, and suggests etiotropic therapy regimens for cases where the causative agent has been identified. It also emphasizes the need for a timely prescription of combined antibiotic therapy with intravenous administration, suggesting the possibility of de-escalation based on microbiological data. A substantial portion of the overview focuses on the respiratory therapy for CAP, outlining a graded algorithm for the treatment of acute respiratory failure based on stage, and describing in detail the most effective and safe invasive and non-invasive respiratory support strategies. The proposed adjuvant therapies include glucocorticosteroids if it is impossible to stabilize hemodynamics by means of adequate hydration and vasopressor support, as well as parenteral anticoagulants to prevent thromboembolic complications. Pneumococcal and influenza vaccines are suggested as CAP prevention strategies for high-risk patients. The publication seeks to highlight the most critical aspects of the draft of the updated clinical recommendations for CAP and encourage their wide discussion across the community of Russian intensive care anesthesiologists and intensivists.
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