Patient selection:pediatric patient being treated for community-acquired pneumonia (CAP)
Assessment: at 48-72 hours after starting the therapy
Clinical findings associated with therapeutic nonresponse:
(1) fever that is persistent or increasing
(2) continued tachycardia
(3) continued signs of respiratory insufficiency (tachypnea, grunting, cyanosis, chest retractions)
(4) oxygen saturation < 90% on room air (FIO2 0.21)
(5) need for supplemental oxygen or ventilatory support
(6) abnormal chest findings on physical exam (abnormal or absent breath sounds, dullness to percussion)
(7) toxic appearance on physician assessment
(8) altered mental status
(9) chest pain or splinting of chest
(10) unable to eat or drink sufficient to meet needs
Laboratory and imaging findings associated with therapeutic nonresponse:
(11) continued leukocytosis and/or left shift with immature neutrophils
(12) persistent elevation in C-reactive protein (CRP) and procalcitonin
(13) laboratory tests continued positive for pathogens
(14) evidence of increased parenchymal involvement on imaging studies
(15) persistent or increasing pleural fluid on imaging studies
