Severe community-acquired pneumonia (SCAP) in the elderly is a common and intractable disease in respiratory medicine, with often non-specific clinical manifestations, mostly associated with underlying disease, and rapid progression, becoming a common cause of death in the elderly. The clinical characteristics and treatment of 98 cases of SCAP in the elderly hospitalized in our hospital from 2000 to 2010 are analyzed to discuss clinical countermeasures for improving the prognosis. Clinical data 1. General data: The diagnosis of 98 elderly SCAP patients met the diagnostic criteria of severe pneumonia in the 1999 (2006) Chinese Medical Association Respiratory Disease Branch Guidelines on the diagnosis and treatment of community-acquired pneumonia. There were 50 male cases and 48 female cases, all aged ≥65 years, with a mean of (74±3 years), and 80 cases combined with underlying disease (81.5%). 2, clinical manifestations: among 98 cases, mental symptoms (apathy, drowsiness, coma) in 62 cases (63.3%); chemical symptoms (loss of appetite, nausea, vomiting) in 50 cases (51%); inspiratory symptoms in 47 cases (47.9%); fever in 42 cases (42.8%); rales in the lungs in 57 cases, all appearing as single/multiple organ dysfunction, the proportion of appearing in descending order Respiratory failure (mainly type 1), circulatory dysfunction, toxic encephalopathy, upper gastrointestinal hemorrhage, renal dysfunction, and a few sepsis, and most of these patients died. 3, laboratory tests: white blood cells are mostly normal, but granulocytes are mostly elevated, anemia, elevated liver enzymes, electrocardiographic myocardial ischemic changes, premature beats, elevated creatinine urea nitrogen, pathogenic examination sputum culture and blood culture positive rate is low, the common pathogenic bacteria from high to low incidence are Escherichia coli, Klebsiella (pneumonia), Acinetobacter baumannii, a few Staphylococcus aureus. 4, affective changes: lung CT shows: lobar pneumonia, bronchopneumonia changes, or scattered patches: cloudy shadow. Treatment principles Active treatment of the original disease, blood culture and sputum culture and understanding of the relevant organ function tests, while taking the following treatment (1) antibiotic application, using heavy hammer therapy: bactericidal agents, wide coverage, adequate amount, early application, and subsequent descending steps according to the disease. (2) Correction of life-threatening organ failure: e.g. fluid resuscitation under close testing, ability to cooperate with patient application of non-invasive positive pressure ventilation for expiratory failure, application of endotoxin scavengers. (3) Nutrition: enteral nutrition is the mainstay, nasal feeding of enteral nutrition solution if necessary. (4) Maintain water-electrolyte and acid-base balance. (5) Strengthen monitoring. Results: 55 cases were cured, 19 cases were abandoned, and 24 cases died among 98 cases. The mortality rate was 43%. It is estimated that there are 2.5 million cases of pneumonia in China every year, of which the elderly account for 70%, and there are many severe cases due to functional failure and concomitant underlying diseases, and its incidence is increasing year by year with the trend of aging of the society, which is also one of the main causes of death in the elderly. In our study, the mortality rate was as high as 43% in 98 cases, which is a decrease from the mortality rate of 75% reported abroad. (2) Few positive pulmonary signs. (3) Most of the symptoms are associated with single/multiple organ failure, with respiratory and circulatory failure being the most common. (4) Granulocytes are mostly elevated, imaging is the main diagnostic tool, and the causative organisms are predominantly G-bacteria. (5) The condition of pneumonia in the elderly changes rapidly, especially in the case of unsatisfactory early control, the condition often deteriorates rapidly, so early detection and appropriate treatment is very important. Treatment tips: (1) Once unexplained psychiatric symptoms or gastrointestinal and unexplained dyspnea in the elderly are detected, early imaging (especially pulmonary CT) is indicated. Blood gas analysis, blood culture and sputum culture must be performed. (2) Adopt the de escalation therapy strategy, and pay attention to the applicable population when applying this strategy, combine the diagnostic criteria of SCAP and the risk factors of multi-drug resistant (MDR) pathogenic infection to individualize the drug selection, and realize the conversion from the initial empiric therapy to the subsequent target therapy in a timely manner, It is the key to successful treatment. (3) Maintain the function of multiple organs throughout the body and prevent multi-organ failure. In patients with hypoxemia or respiratory distress, the use of noninvasive ventilators is highly valued, and noninvasive ventilation can be tried, even in patients with more sputum. The efficacy of noninvasive ventilation should be evaluated after 1 to 2 h of noninvasive ventilation treatment. In case of severe hypoxemia (oxygen and index PaO2 /FiO2 < 150) or bilateral alveolar infiltration, emergency tracheal intubation is required. Fluid resuscitation for circulatory collapse should be done under close monitoring. (4) Pay attention to nutritional support therapy, improve immunity, correct electrolyte disorders, and eliminate inflammatory mediators. It can effectively improve the anti-infection effect. (5) The rational treatment of the underlying epidemic is the basis for reducing mortality, and the application of immune enhancers when necessary. In conclusion early detection of severe acquired pneumonia in the elderly and a comprehensive treatment throughout the program is the key to success. It is true that the success rate of resuscitation has increased through our corresponding treatment, but the mortality rate of elderly SCAP in this group is still as high as 43%, and our analysis is likely that the unknown etiology is the key.