Community-acquired pneumonia hospital admission decision

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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 direct admission to the intensive care unit (ICU).

ICU Admission Decision

Patients with severe community-acquired pneumonia should be admitted to the ICU if any of the following is present:

• Invasive mechanical ventilation (major criteria), OR

• Septic shock with need for vasopressors (major criteria), OR

• 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