Patient selection: pediatric patient > 3 months and < 18 years of age
Major criteria:
(1) shock that is refractory to fluid resuscitation
(2) need for acute ventilatory assistance (invasive mechanical ventilation or acute need for noninvasive positve pressure ventilation or NIPPV)
(3) hypoxemia requiring an FIO2 greater than the inspired concentration or flow feasible on a general care ward
Minor criteria:
(1) respiratory rate > respiratory rate for age (WHO cutoffs, see below)
(2) apnea
(3) increasing work of breathing
(4) PaO2 to FIO2 ratio < 250
(5) multilobar infiltrate on chest X-ray
(6) PEWS score >= 7 (see 42.11.10)
(7) altered mental status
(8) hypotension
(9) pleural effusion
(10) comorbid condition associated with increased morbidity and mortality (sickle cell disease, immunosuppression, immunodeficiency)
(11) unexplained metabolic acidosis
where:
• WHO cutoffs for respiratory rate: > 60 breaths per minute if < 2 months old; > 50 breaths per minute if 2 to 12 months old; > 40 breaths per minute if 1 to 5 years old; > 20 breaths per minute if > 5 years old
Criteria for moderate to severe CAP - one or both of the following:
(1) >= 1 major criteria
(2) >= 2 minor criteria
A patient with moderate to severe CAP should be admitted to the intensive care unit (ICU) or have continuous cardiopulmonary monitoring.
