Patient selection: community-acquired pneumonia requiring hospitalization
Outcome: clinical deterioration following admission
Criteria for clinical failure – one or more of the following:
(1) acute respiratory failure with need for mechanical ventilation (invasive or noninvasive)
(2) acute hemodynamic deterioration with need for fluid resuscitation (> 40 mL per kg), vasopressors or an invasive procedure (cardioversion, pericardial drainage, etc)
(3) in-hospital death within 28 days of admission
Clinical failure is not defined by severe pneumonia or sepsis on admission although these are risk factors for failure.
Clinical failure is termed early if it occurs <= 3 days after hospital admission.
It is termed late if it occurs > 3 days after hospital admission.
A patient who deteriorates needs to be evaluated for possible underlying causes. Conditions that may underly clinical failure include:
(1) sepsis or septic shock
(2) acute myocardial infarction
(3) progression of the pneumonia
(4) hospital-acquired pneumonia
(5) exacerbation of heart failure
