Daily Bolus of LR: ICU Admissions in Pneumonia

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November 20, 2012 by dailybolusoflr

ICU Admissions in Pneumonia
The 2007 IDSA/ATS guidelines1 created criteria to better categorize severe pneumonia compared to previous scoring systems like PORT/CURB-65. Approximately 10% of admissions are directly to an ICU and another 30% of non-ICU admissions will end up in the ICU during their hospital stay.2 Given these numbers, IDSA/ATS created a scoring system to categorized severe pneumonia and help with earlier ICU admission from the ED.

Admission to an ICU is suggested when a patient has 1 major criteria or 3 minor criteria.

Minor criteria
      • Respiratory rate >30 breaths/min
      • PaO2/FiO2 ratio <250
      • Multilobar infiltrates
      • Confusion/disorientation
      • Uremia (BUN >20 mg/dL)
      • Leukopenia (WBC <4000)
      • Thrombocytopenia (platelets <100,000)
      • Hypothermia (core temp <36C)
      • Hypotension requiring aggressive fluid resuscitation
Major criteria
      • Invasive mechanical ventilation
      • Septic shock with need for vasopressors

Another scoring system called the Risk of Early Admission to the Intensive Care Unit index (REA-ICU index) has been established for patients without obvious need for ICU (vasopressors and mechanical ventilation). Results have been very similar to the IDSA/ATS guidelines. Neither have been proven better than the other.

You can see the REA-ICU index article at:

1. Infectious Diseases Society of America/American Thoracic Society consensus guidelines
on the management of community-acquired pneumonia in adults.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF,
File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society
of America, American Thoracic Society
Infect Dis. 2007; 44 Suppl 2:S27.

2. Association between timing of intensive care unit admission and outcomes for
emergency department patients with community-acquired pneumonia.
Renaud B, Santin A, Coma E, et al. Crit Care Med. 2009; 37:2867-74.

3. Risk Stratification of early admission to the intensive care unit of patients with no
major criteria of severe community-acquired pneumonia: development of an international
prediction rule.
Renaud B, Labarere J, Coma E, Santin A, Hayon J, et al. Crit Care. 2009;13(2):R54

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