| | | | |
| RECOMMENDATIONS | | |
| | | | |
| Recommendation |
| Hospital admission decision. |
| Imperative: | Severity-of-illness scores, such as the CURB-65 criteria (confusion, uremia, respiratory rate, low blood pressure, age 65 years or greater), or prognostic models, such as the Pneumonia Severity Index (PSI), can be used to identify patients with CAP who may be candidates for outpatient treatment. | |
|
| {Rec_1:Imp_ 1} |
| Imperative: | Objective criteria or scores should always be supplemented with physician determination of subjective factors, including the ability to safely and reliably take oral medication and the availability of outpatient support resources. | |
|
| {Rec_1:Imp_ 2} |
| Conditional: | For patients with CURB-65 scores ≥2, more-intensive treatment that is, hospitalization or, where appropriate and available, intensive in-home health care services is usually warranted. | |
|
| {Rec_1:Cond_ 1} |
| | | | |
| Recommendation |
| ICU admission decision. |
| Conditional: | Direct admission to an ICU is required for patients with septic shock requiring vasopressors or with acute respi- ratory failure requiring intubation and mechanical ven- tilation. | |
|
| {Rec_2:Cond_ 2} |
| Conditional: | Direct admission to an ICU or high-level monitoring unit is recommended for patients with 3 of the minor criteria for severe CAP listed in table 4 | |
|
| {Rec_2:Cond_ 3} |
| | | | |
| Recommendation |
| Diagnostic Testing |
| Imperative: | In addition to a constellation of suggestive clinical features, a demonstrable infiltrate by chest radiograph or other imaging technique, with or without supporting mi- crobiological data, is required for the diagnosis of pneumonia. | |
|
| {Rec_3:Imp_ 4} |
| | | | |
| Recommendation |
| Recommended diagnostic tests for etiology. |
| Conditional: | Patients with CAP should be investigated for specific pathogens that would significantly alter standard (empirical) management decisions, when the presence of such pathogens is suspected on the basis of clinical and epidemiologic clues. | |
|
| {Rec_2:Cond_ 2} |
| Imperative: | Routine diagnostic tests to identify an etiologic diagnosis are optional for outpatients with CAP | |
|
| {Rec_2:Imp_ 2} |