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Review
. 2020 Feb 19;29(155):190126.
doi: 10.1183/16000617.0126-2019. Print 2020 Mar 31.

Community-acquired pneumonia in critically ill very old patients: a growing problem

Catia Cillóniz  1 , Cristina Dominedò  2 , Juan M Pericàs  3 , Diana Rodriguez-Hurtado  4 , Antoni Torres  5
Affiliations
Review

Community-acquired pneumonia in critically ill very old patients: a growing problem

Catia Cillóniz et al. Eur Respir Rev. .

Abstract

Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit.

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Conflict of interest statement

Conflict of interest: C. Cillóniz has nothing to disclose. Conflict of interest: C. Dominedò has nothing to disclose. Conflict of interest: J.M. Pericàs has nothing to disclose. Conflict of interest: D. Rodriguez-Hurtado has nothing to disclose. Conflict of interest: A. Torres has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
General recommendations for the management of critically ill very old community-acquired pneumonia (CAP) patients. PSI: pneumonia severity index; ATS: American Thoracic Society; ICU: intensive care unit. #: in addition to the antibiotics recommended in guidelines, ceftaroline+macrolide/ceftobiprole+macrolide could be a good option for this population.
FIGURE 2
FIGURE 2
Changes in the adaptive and innate immune system. INF: interferon; IL: interleukin; TNF: tumour necrosis factor; Ig: immunoglobulin.
FIGURE 3
FIGURE 3
Clinical Frailty Scale. IADLs: instrumental activities of daily living.
FIGURE 4
FIGURE 4
Prevention of community-acquired pneumonia.
See this image and copyright information in PMC

Comment in

References

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MeSH terms