Diagnosis and Assessment
Site of Care Management Decisions Hospital
ÎChildren and infants who have moderate to severe CAP as defined by several factors including respiratory distress and hypoxemia (sustained saturation of peripheral oxygen [SpO2
] < 90 % at sea level)
(Table 2) should be hospitalized for management including skilled pediatric nursing care. (SR-H)
ÎInfants 3-6 months of age with suspected bacterial CAP are likely to benefit from hospitalization. (SR-L)
ÎChildren and infants with a suspicion or documentation of CAP caused by a pathogen with increased virulence such as community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) should be hospitalized. (SR-L)
ÎChildren and infants for whom there is concern about careful observation at home, who are unable to comply with therapy, or unable to follow-up should be hospitalized. (SR-L)
Intensive Care Unit
ÎA child should be admitted to an intensive care unit (ICU) if the child requires invasive ventilation via a nonpermanent artificial airway (eg, endotracheal tube). (SR-H)
ÎA child should be admitted to an ICU or a unit with continuous cardiorespiratory monitoring capabilities if the child acutely requires use of noninvasive positive pressure ventilation (eg, continuous positive airway pressure [CPAP], or bilevel positive airway pressure [BIPAP]). (SR-VL)
ÎA child should be admitted to an ICU or a unit with continuous cardiorespiratory monitoring capabilities if the child has impending respiratory failure. (SR-M)
ÎA child should be admitted to an ICU or a unit with continuous cardiorespiratory monitoring capabilities if the child has sustained tachycardia, inadequate blood pressure or need for pharmacologic support of blood pressure or perfusion. (SR-M)
ÎA child should be admitted to an ICU if pulse oximetry is < 92% on inspired oxygen of ≥ 0.50. (SR-L)
ÎA child should be admitted to an ICU or a unit with continuous cardiorespiratory monitoring capabilities if the child has altered mental status, whether due to hypercarbia or hypoxia, as a result of pneumonia. (SR-L)
ÎSeverity of illness scores should NOT be used as the sole criteria for ICU admission but should be used in the context of other clinical, laboratory, and radiologic findings. (SR-L)
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