Goal: To identify a patient with CAP who should be admitted to the intensive care unit (ICU).
Major criteria:
(1) invasive mechanical ventilation (with intubation)
(2) septic shock requiring vasopressor support
Minor criteria:
(1) respiratory rate >= 30 breaths per minute
(2) PaO2/FIO2 <= 250
(3) multilobar lung infiltrate on imaging studies
(4) altered mental status (confusion, disorientation)
(5) BUN >= 20 mg/dL (uremia)
(6) white blood cell count < 4,000 per µL (leukopenia) due to infection alone
(7) platelet count < 100,000 per µL (thrombocytopenia)
(8) core body temperature < 36°C (hypothermia)
(9) hypotension requiring aggressive fluid resuscitation
(10) need for noninvasive ventilation (if respiratory rate or PaO2/FIO2 ratio do not trigger)
where:
• Septic shock = sepsis-induced hypotension with hypoperfusion, persisting despite adequate fluid replacement.
• The elevated BUN should not be due to dehydration.
• Additional minor criteria may include: hypoglycemia in a patient without diabetes; acute alcohol withdrawal; hyponatremia; unexplained metabolic or lactic acidosis; cirrhosis; asplenia.
Criteria for admission to the ICU - either of the following:
(1) one or both major criteria
(2) 3 or more minor criteria
