From: Severe community-acquired pneumonia: timely management measures in the first 24 hours
Intervention | Patient population | Number of patients | Number with pneumoniaa | Mortality reduction | Mortality definition | Risk (95 % CI) | Evidence quality | Selected reference |
---|---|---|---|---|---|---|---|---|
CAP severity assessment tools to guide management | Severe CAP in hospital | 348 | 348 with CAP | Yes | Hospital | Adjusted OR 0.24 (0.09–0.67) | Low; before-and-after study | [27] |
Guideline-concordant antibiotics | CAP in hospital | 1288 | 1288 with CAP | Yes | Hospital mortality | Adjusted OR 0.55 (0.30–0.90) | Low; observational study | [39] |
Macrolide combination treatment | Severe CAP in ICUs | 8872 | 8872 with CAP | Yes | Hospital, ICU, 28-day or 30-day | RR 0.84 (0.71–1.00) | Moderate; systematic review of observational studies | [48] |
Early antibiotics within 1 hour | Sepsis and septic shock | 11,017 | Data not available | Uncertain | Hospital or 28-day | OR 0.68 (0.42–1.12) | Moderate; systematic review of observational studies | [56] |
Early antibiotics after septic shock | Septic shock | 2154 | 838 | Yes | Hospital | Adjusted OR 0.89 (0.88–0.91) per hour earlier | Low; observational study | [55] |
Early goal-directed therapy | Septic shock | 4201 | 1278 | Uncertain | 90-day | OR 0.99 (0.86–1.15) | High; systematic review of RCTs | [66] |
High-flow nasal cannula | PaO2/FIO2 ≤ 300 mmHg | 310 | 254 (197 with CAP) | Yes | 90-day | HR 0.50 (0.25–0.99) | High; RCT | [71] |
Low tidal volumes and plateau pressures | ARDS with PaO2/FIO2 ≤ 300 mmHg | 861 | 69 | Yes | Hospital | RR 0.78 (0.65–0.93) | High; RCT | [76] |
High positive-end expiratory pressure | ARDS with PaO2/FIO2 ≤ 200 mmHg | 2299 | 1145 | Yes | Hospital | Adjusted RR 0.90 (0.81–1.00) | Moderate; systematic review of RCTs; conflicting results with other systematic reviews | [79] |
Low driving pressure | ARDS with PaO2/FIO2 ≤ 300 mmHg | 3562 | 1314b | Yes | Hospital at 60 days | RR 0.71 (0.66–0.76) for each 1-SD decrease in driving pressure | Moderate; systematic review of RCTs of different objectives and methods | [77] |
Neuromuscular blockade | ARDS with PaO2/FIO2 < 150 mmHg | 339 | 262 (130 with CAP) | Yes | 90-day | Adjusted HR 0.68 (0.48–0.98) | High; RCT | [81] |
Prone positioning | ARDS with PaO2/FIO2 < 150 mmHg | 466 | 281 | Yes | 28-day | HR 0.39 (0.25–0.63) | High; RCT | [83] |
Corticosteroids | Severe CAP according to severity assessment tools | 388 | 388 with CAP | Uncertain | Varies between RCTs | RR 0.39 (0.20–0.77) | Moderate; systematic review of RCTs; conflicting results with other systematic reviews | [87] |
Care bundles | CAP in hospital | 2118 | 2118 with CAP | Yes | 30-day | Adjusted OR 0.59 (0.37–0.95) | Low; before-and-after study | [97] |