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:
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