BACKGROUND: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with communityacquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of .dying of severe community-acquired pneumonia. METHODS: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. RESULTS: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnea, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+)cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Save patients death(70%) occured after admission within the first five days, and a mean duration of hospitalization was 11.2 days. CONCLUSION: As the results show most death occured within the first days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.
Adult ; Anoxia ; Anti-Bacterial Agents ; Azotemia ; Cyanosis ; Enterobacter ; Female ; Hope ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypotension ; Critical Care ; Korea ; Leukocytosis ; Leukopenia ; Male ; Medical Records ; Mortality ; Patients' Rooms ; Pneumonia* ; Prognosis ; Prospective Studies ; Respiratory Insufficiency ; Retrospective Studies ; Sputum ; Tachypnea ; Vancomycin

BACKGROUND AND OBJECTIVES : Microvascular integrity has been associated with the clinical outcomes in acute myocardial infarction (AMI). The present study was conducted to determine the value of many microvascular indexes assessed by an intracoronary (IC) pressure/Doppler wire in AMI following primary PCI for detecting viable myocardium by comparing with the 18F-fluorodeoxyglucose uptake rate (%FDG uptake) on positron-emission tomography (PET). SUBJECTS AND METHODS : We studied 35 patients who had their first AMI (age: 56+/-12, male: 30). After primary PCI, the TMPG (TIMI myocardial perfusion grade) was assessed. We measured the coronary flow reserve (CFR), the diastolic deceleration time (DDT), the coronary wedge pressure (Pcw), the Pcw/ Pa (mean aortic pressure) and the hyperemic microvascular resistance index (hMVRI) by an IC Doppler/ pressure wire. 18FDG PET scan was obtained at 7 days after the primary PCI; viable myocardium was defined that the %FDG uptake was more than 50% in infarct-related myocardium. RESULTS : There were significant correlations between TMPG, CFR, Pcw, Pcw/Pa, DDT, hMVRI and %FDG uptake (r=0.651, p<0.001; r=0.386, p=0.020; r=-0.388, p=0.021; r=-0.473, p=0.004; r=0.589, p<0.001; r=-0.442, p=0.008, respectively). The best cutoff values and area under curves (AUC) of the CFR, Pcw, Pcw/Pa, DDT and hMVRI for 50% FDG uptake were 1.8 (0.737), 27 mmHg (0.600), 0.33 (0.660), 600 msec (0.802) and 2.55 mmHg.cm-1.sec (0.768), respectively. The DDT had a significantly higher AUC than that of Pcw (p=0.029) and it was an independent index to predict the myocardial viability (p=0.011). CONCLUSION : DDT was the most reliable hemodynamic microvascular index that was assessed within 24 hours following primary PCI for predicting the viable myocardium in AMI patients.
Area Under Curve ; DDT ; Deceleration ; Fluorodeoxyglucose F18 ; Hemodynamics ; Humans ; Male ; Myocardial Infarction ; Myocardium ; Perfusion ; Positron-Emission Tomography ; Pulmonary Wedge Pressure