• Mechanical ventilation with noninvasive positive pressure ventilation

• Septic shock requiring vasopressors (fluid refractory shock)

• Pulse oximetry of ≤90% on room air

• Hypoxia requiring FiO2 greater than inspired concentration or flow feasible in general care area

ICU Admission for Children:

• Respiratory rate higher than WHO classification for age, Pa)2/Fi02 ≤250, Apnea

• PEWS score >6, confusion, hypotension, unexplained acidosis

• Multilobar infiltrates, presence of effusion

• Increased work of breathing (eg, retractions, dyspnea, nasal flaring, grunting)

• Unexplained Acidosis

• Comorbid conditions (HgbSS, immunosuppression, immunodeficiency)

• Respiratory Distress Defined:

  • Tachypnea, respiratory rate, breaths/min
    • Age 0–2 months: >60
    • Age 2–12 months: >50
    • Age 1–5 Years: >40
    • Age >5 Years: >20

• Age: Greater than 65 years or less than 2 years (may be less than 5 years)

• Prior hospitalization (Children)

• Aspiration pneumonia with previous episodes of pneumonia in the last year (children)

• B-lactam within past 3 months (fluoroquinolones (FQ)/macrolides increase resistance as well)

• Immunosuppressive illness (including treatment with corticosteroids)

• Multiple medical comorbidities: DM, CRI, CHF, CAD, malignancy, chronic hepatic disease

• Exposure to child in day care center

• Unimmunized or under immunized

• Prior antibiotic therapy (especially with FQ)

• End-stage renal disease

• Prior influenza

• ICU admission (children)

• Necrotizing or cavitary infiltrates (children)

• Empyema (children)

• Recent antibiotic therapy

• Tracheostomy

• Multiple medical comorbidities

• Underlying cardiopulmonary disease

• Structural lung disease (bronchiectasis, CF, CP + chronic aspiration)

• Corticosteroid therapy (>10 mg prednisone/day)

• Antibiotic therapy for >7 days in past month

• Malnutrition