Community-acquired pneumonia hospital admission decision: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Community-acquired pneumonia}} | {{Community-acquired pneumonia}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{Rim}} | ||
==Overview== | ==Overview== | ||
The initial step of the management plan of a patient with community acquired pneumonia is the decision on hospital admission (inpatient vs. outpatient treatment). If the patient is to be admitted to the hospital, a decision should be made as to whether there should be an admission to the general medical floor or | The initial step of the management plan of a patient with community acquired pneumonia is the decision on hospital admission (inpatient vs. outpatient treatment). If the patient is to be admitted to the hospital, a decision should be made as to whether there should be an admission to the general medical floor or to the [[intensive care unit]] ([[ICU]]). | ||
==Hospital Admission Decision== | ==Hospital Admission Decision== | ||
Patients with high-risk community-acquired pneumonia should be admitted to the hospital for treatment. Severity of illness scores, such as [[CURB 65]] and [[Pneumonia Severity Index (PSI)]], are used to stratify patients. | |||
Admission to the hospital is warranted in the following cases:<ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref> | |||
* [[CURB 65]] ≥2, '''''OR''''' | |||
* High [[PSI]] score: There is no cut-off value for the [[PSI]] score; a higher score is associated with a higher risk of morbidity and mortality. A Risk Class I pneumonia patient can be sent home on oral antibiotics. A Risk Class II-III pneumonia patient may be sent home with IV antibiotics or treated and monitored for 24 hours in hospital. Patients with Risk Class IV-V pneumonia patient should be hospitalized for treatment. | |||
==ICU Admission Decision== | ==ICU Admission Decision== | ||
Patients with severe community-acquired pneumonia should be admitted to the [[ICU]] if any of the following is present:<ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref> | Patients with severe community-acquired pneumonia should be admitted to the [[ICU]] if any of the following is present:<ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref> | ||
* Invasive mechanical ventilation (major criteria), OR | * Invasive mechanical ventilation (major criteria), '''''OR''''' | ||
* [[Septic shock]] with need for [[vasopressor]]s (major criteria), OR | * [[Septic shock]] with need for [[vasopressor]]s (major criteria), '''''OR''''' | ||
* 3 of the following minor criteria: | * At least 3 of the following minor criteria: | ||
** [[Respiratory rate]] >30 breaths/min | ** [[Respiratory rate]] >30 breaths/min | ||
** [[PaO2]]/FiO2 ratio <250 | ** [[PaO2]]/FiO2 ratio <250 | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Pneumonia]] | [[Category:Pneumonia]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 21:02, 29 July 2020
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Community-Acquired Pneumonia Microchapters |
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Differentiating Community-acquired pneumonia from other Diseases |
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Directions to Hospitals Treating Community-acquired pneumonia |
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Risk calculators and risk factors for Community-acquired pneumonia hospital admission decision |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
The initial step of the management plan of a patient with community acquired pneumonia is the decision on hospital admission (inpatient vs. outpatient treatment). If the patient is to be admitted to the hospital, a decision should be made as to whether there should be an admission to the general medical floor or to the intensive care unit (ICU).
Hospital Admission Decision
Patients with high-risk community-acquired pneumonia should be admitted to the hospital for treatment. Severity of illness scores, such as CURB 65 and Pneumonia Severity Index (PSI), are used to stratify patients.
Admission to the hospital is warranted in the following cases:[1]
- CURB 65 ≥2, OR
- High PSI score: There is no cut-off value for the PSI score; a higher score is associated with a higher risk of morbidity and mortality. A Risk Class I pneumonia patient can be sent home on oral antibiotics. A Risk Class II-III pneumonia patient may be sent home with IV antibiotics or treated and monitored for 24 hours in hospital. Patients with Risk Class IV-V pneumonia patient should be hospitalized for treatment.
ICU Admission Decision
Patients with severe community-acquired pneumonia should be admitted to the ICU if any of the following is present:[1]
- Invasive mechanical ventilation (major criteria), OR
- Septic shock with need for vasopressors (major criteria), OR
- At least 3 of the following minor criteria:
- Respiratory rate >30 breaths/min
- PaO2/FiO2 ratio <250
- Multilobar infiltrates
- Confusion/disorientation
- Uremia (BUN >20 mg/dL)
- Leukopenia (WBC <4000 cells/mm3)
- Thrombocytopenia (platelets <100,000 cells/mm3)
- Hypothermia (temperature <36 degrees C)
- Hypotension that requires aggressive fluid resuscitation
References
- ↑ 1.0 1.1 Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083. Retrieved 2012-09-06. Unknown parameter
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