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Description

The American Thoracic Society (ATS) developed a definition for severe, hospital-acquired pneumonia (HAP).


 

Hospital acquired pneumonia:

(1) pneumonia occurring >= 48 hours after admission to the hospital

(2) excluded if the pneumonia was incubating at the time of admission

 

Criteria for severe pneumonia:

(1) admission to the intensive or critical care unit

(2) respiratory failure

(3) changes on chest radiographs

(4) evidence of severe sepsis with hypotension and/or end-organ dysfunction

 

Admission to the intensive care unit:

(1) the patient may already be in the intensive care unit

(2) the onset of pneumonia may necessitate admission to a critical care unit

 

Respiratory failure – either of the following:

(1) need for mechanical ventilation

(2) need for > 35% oxygen to maintain an arterial oxygen saturation > 90%

 

Changes on lung radiographs - one or more of the following:

(1) rapid radiographic progression

(2) multilobar pneumonia

(3) cavitation of a lung infiltrate

 

Findings in severe sepsis with hypotension and/or end-organ dysfunction :

(1) shock, with systolic blood pressure < 90 mm Hg or diastolic blood pressure < 60 mm Hg

(2) requirement for vasopressors for more than 4 hours

(3) urine output < 20 mL/h or a total urine output < 80 mL in 4 hours (unless another explanation is available)

(4) acute renal failure requiring dialysis

 

where:

• The definition of severe sepsis is not definitively stated in the article. I will use the present of (1 or 2) and/or (3 or 4).

 


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