JOURNAL

NAME: Bonilla, Yla Katrina C. YEAR & SECTION: BSN 4-2

CLINICAL INSTRUCTOR: Frances Gia Jalandoni, RN DATE: 3/05/2024

MANAGEMENT OF PNEUMONIA IN CRITICALLY ILL PATIENTS

Cilloniz C, Torres A, Niederman M. (2021). Management of pneumonia in critically ill patients BMJ
2021; 375: e065871 doi:10.1136/bmj-2021-06587 https://www.bmj.com/content/bmj/375/bmj-2021-
065871.full.pdf
Source of Article: BMJ, Google Scholar
Key Terms: pneumonia, severe respiratory infection, pneumonia in critically ill, community acquired
pneumonia, intensive care pneumonia, hospital acquired pneumonia, ventilator associated pneumonia,
management of pneumonia, diagnosis of pneumonia

ABSTRACT: Severe pneumonia is associated with high mortality (short and long term), as well as
pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate
antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill
patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship.
However, establishing an etiological diagnosis is challenging in most patients, especially in those with
chronic underlying disease; those who received previous antibiotic treatment; and those treated with
mechanical ventilation. Furthermore, as antimicrobial therapy must be empiric, national and international
guidelines recommend initial antimicrobial treatment according to the location’s epidemiology; for
patients admitted to the intensive care unit, specific recommendations on disease management are
available. Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia.
Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different
perspectives on host immunological responses, assessment of illness severity, microbial causes, risk
factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options.

QUESTIONS:
1. What is the significance of the research article you have chosen in your Related Learning
Experience?
As a nursing student, the research article I've chosen holds immense significance in shaping my
learning experience and understanding of the complexities surrounding severe pneumonia management.
The article underscores the critical nature of early diagnosis and timely initiation of antimicrobial
treatment for critically ill patients, emphasizing the direct impact on short and long-term mortality rates,
along with the potential for various complications. The recognition of the challenges in establishing an
etiological diagnosis, particularly in patients with chronic underlying diseases, a history of prior antibiotic
treatments, or those on mechanical ventilation, resonates deeply with the practical realities of patient care.
It emphasizes
the multifaceted nature of severe pneumonia and the need for a comprehensive approach to address its
intricacies. The study's focus on antimicrobial stewardship and the importance of identifying the
underlying causative pathogen aligns with the core principles of responsible and effective nursing
practice. It underscores the complexities of empirical antimicrobial therapy and the necessity of tailoring
treatment based on local epidemiology, reinforcing the importance of region-specific guidelines in clinical
decision-making. The specific recommendations for disease management in the intensive care unit (ICU)
setting highlight the specialized considerations required for critically ill patients. As a nursing student
aspiring to work in intensive care, understanding and implementing these recommendations become
essential components of providing high-quality care to individuals with severe pneumonia. The article's
assertion that adherence to pneumonia guidelines is linked to improved outcomes serves as a guiding
principle for my future nursing practice. It emphasizes the importance of evidence-based care and aligning
clinical decisions with established guidelines to enhance patient survival rates. Moreover, the research
article encourages me to appreciate the ongoing and expansive nature of research in severe pneumonia. It
prompts a mindset of continuous learning, urging nursing students like me to engage with different
perspectives on host immunological responses, illness severity assessments, microbial causes, risk factors
for multidrug-resistant pathogens, and evolving diagnostic and therapeutic options.

In conclusion, as a nursing student, this research article becomes a valuable resource that not only
enhances my understanding of severe pneumonia but also shapes my approach to patient care. It serves as
a guidepost, emphasizing the importance of evidence-based practice, adherence to guidelines, and a
continuous commitment to learning in the dynamic field of healthcare.

2. What are the implication of the finding in your patient care?

As a nursing student, the implications of the findings from the research article on severe
pneumonia management have profound significance for my future patient care. The recognition of the
critical importance of early diagnosis and prompt initiation of antimicrobial treatment in critically ill
patients with severe pneumonia directly informs my understanding of the urgency and time-sensitive
nature of patient interventions. The acknowledgment of challenges in establishing an etiological diagnosis,
especially in patients with underlying chronic diseases or those undergoing mechanical ventilation,
emphasizes the need for careful and thorough assessments. As a future nurse, this highlights the
importance of vigilance in monitoring patients' clinical histories and responding adeptly to the
complexities involved in severe pneumonia cases. The focus on antimicrobial stewardship and tailoring
treatment based on local epidemiology underscores the responsibility of ensuring judicious use of
antimicrobials. It encourages an awareness of the regional patterns of microbial resistance, reinforcing the
importance of evidence-based decision-making in prescribing antibiotics. This has implications for my
role as a future nurse in advocating for prudent antimicrobial use, contributing to efforts in combating
antibiotic resistance and improving patient outcomes. The specific recommendations for disease
management in the intensive care unit (ICU) setting provide valuable insights for my future practice in
critical care nursing. Understanding and implementing these recommendations, such as tailored treatments
and specialized considerations for critically ill patients, will be crucial in providing comprehensive and
effective care to individuals with severe
pneumonia in the ICU. The article's emphasis on adherence to pneumonia guidelines as associated with
better outcomes directly influences my approach to patient care. It instills a commitment to evidence-
based practice, encouraging me to stay informed about the latest guidelines and incorporate them into my
nursing interventions. This commitment to guidelines aligns with the goal of optimizing patient outcomes
and ensuring a standardized, quality level of care. Furthermore, the encouragement to engage with
different perspectives on host immunological responses, illness severity assessments, microbial causes,
and evolving diagnostic and therapeutic options fosters a mindset of continuous learning. As a nursing
student, this implies an ongoing commitment to staying updated on the latest research and advancements
in pneumonia management, ensuring that my practice remains informed and adaptable.

In conclusion, the implications of the research findings for my patient care are vast and
multifaceted. They guide my understanding of the urgency in severe pneumonia cases, stress the
importance of careful assessments, advocate for antimicrobial stewardship, provide insights for ICU-
specific care, and encourage a commitment to evidence-based practice and lifelong learning. As I progress
in my nursing career, these implications will shape my approach to providing high-quality care to
individuals affected by severe pneumonia.

3. What intervention/innovation relevant new findings was used of implemented in the study/ies
reviewed?
The reviewed research underscores several innovative approaches in the diagnosis and treatment
of pneumonia, particularly in severe cases. Metagenomics utilizing next-generation sequencing (NGS)
offers a promising avenue for accurate and rapid detection of multiple pathogens in a single assay,
potentially transforming pneumonia management. Plasma microRNA signatures and advanced diagnostic
technologies, such as the Filmarray pneumonia test, further contribute to improved diagnostic precision.
The study also highlights the integration of guidelines from reputable organizations, guiding key aspects
of pneumonia management, including pathogen identification, antimicrobial treatment, and prevention
strategies. For severe Community-Acquired Pneumonia (CAP), the recommendations emphasize a
personalized approach with initial treatment combinations based on specific risk factors, biomarker-
guided therapy duration, and considerations for adjunctive corticosteroid therapy. In the context of
Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP), the challenges in
diagnosis are acknowledged, and recommendations prioritize tailored treatment regimens based on
individual risk factors, including multidrug-resistant pathogens and MRSA. The evolving landscape of
newer agents and inhaled antibiotics reflects a dynamic response to highly resistant pathogens, and the
potential for shorter treatment durations under specific conditions is recognized.

Overall, these interventions and innovations offer a more personalized and efficient approach to
pneumonia management, paving the way for improved patient outcomes and enhanced clinical practices.
The synthesis of cutting-edge technologies and evidence-based guidelines marks a significant step forward
in advancing the field of pneumonia care.