Chapter 26. Pneumonia

Community-acquired pneumonia (CAP)

Community-dwelling outpatient, or inpatient if diagnosis w/in 48h of admission

Healthcare-associated pneumonia (HCAP)

Community-dwelling patient admitted w/recent healthcare contact, recent hospitalization (≥2d in previous 90d), residence in a nursing home or LTCF, home infusion therapy or wound care, or chronic dialysis

Hospital-acquired pneumonia (HAP)

≥48h after hospital admission

Ventilator-associated pneumonia (VAP)

48–72h after endotracheal intubation

Age

Objective Findings

Score

Class

Death, %

Men

Women

NH resident

Comorbidities

Neoplastic

Liver

CHF

Cerebrovascular

Renal

+ # of y

+ # of y

–10

+10

+30

+20

+10

+10

+10

AMS

RR ≥30

SBP <90

T <95 or ≥104°F

HR ≥125

Arterial pH <7.35

BUN ≥30

Na <130

Glucose ≥250

Hct <30

PaO2 <60

Pleural effusion

+20

+20

+20

+15

+10

+30

+20

+20

+10

+10

+10

+10

n/a*

≤70

71–90

91–130

>130

I

II

III

IV

V

<0.5

<1

1–3

∼9

∼30

Class

I–II

II–III

IV–V

Point of Care

Assess for outpt

Assess for inpt

Assess for ICU

Confusion

+1

Score

0–1

2

≥3

Death, %

1.5

∼9

22

Point of Care

Assess for outpt

Assess for inpt

Assess for ICU

Uremia (BUN ≥20)

+1

Respiratory rate ≥30

+1

Blood pressure (<90/60)

+1

Age ≥65

+1

Major Criteria

Minor Criteria

Invasive mechanical ventilation

Septic shock with need for vasopressors

Note

   ≥1 major &/or ≥3 minor criteria → ICU

   ≥3 minor criteria alone → need ...