Reduction in Deaths due to Severe Pneumonia with all-Inclusive Treatment
SubhashchandraDaga*, Bela Verma , Chhaya Valvi , Minoti Ayarekar
Introduction
Pneumonia is the leading infectious cause of death among children under-five. Data shows that the majority of childhood pneumonia deaths are due to severe pneumonia/severe disease. Severe pneumonia is diagnosed by the presence of fast breathing/chest indrawing with any general danger sign. Case management remains the cornerstone of pneumonia control strategies. Present study aims at knowing
if an all-inclusive treatment, that covers severe pneumonia and danger signs, especially sepsis and impaired perfusion, reduces risk of death.
Methods
Consecutively admitted 616 subjects with critical illness were prospectively studied in a large public hospital attached to a medical college. Of these, the subjects with severe pneumonia (370) received antibiotic and oxygen routinely. In addition, fluid bolus and inotropes were administered as per protocol. Subjects with compensated shock received inotropes alone and those with decompensated shock received
fluid bolus as well. Outcome variable of interest was survival to hospital discharge or death. Binary Logistic Regression between ‘outcome’ as the dependent variable and a set of independent (predictor) variables was performed.
Results
Hospital stay, admission type, shock, dehydration, sepsis on blood counts, and pH less than 7.3 were significant predictors of adverse outcome. Age, gender, malnutrition, chest indrawing, fever, HIV infection, anemia (Hb <7 g) and consolidation on chest X-ray did not predict death.
Conclusion
The risk of death with severe pneumonia in developing countries may reduce with a combined treatment for severe pneumonia and sepsis/impaired perfusion. However, a randomized controlled trial is needed to confirm the findings.
