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).
