November 20, 2012 by dailybolusoflr
Admission to an ICU is suggested when a patient has 1 major criteria or 3 minor criteria.
- Respiratory rate >30 breaths/min
- PaO2/FiO2 ratio <250
- Multilobar infiltrates
- Uremia (BUN >20 mg/dL)
- Leukopenia (WBC <4000)
- Thrombocytopenia (platelets <100,000)
- Hypothermia (core temp <36C)
- Hypotension requiring aggressive fluid resuscitation
- 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.
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
Renaud B, Labarere J, Coma E, Santin A, Hayon J, et al. Crit Care. 2009;13(2):R54