Pneumonia, Community-Acquired — Assess Patient for Presence and Severity of Pneumonia — Clinical Pathway: All Settings

Community Acquired Pneumonia Clinical Pathway — All Settings

Assess Patient for Presence and Severity of Pneumonia

History and Physical Examination

The clinical diagnosis of pneumonia is a challenging one but requires historical and/or physical evidence of acute infection with fever and signs or symptoms of respiratory distress. Generally, combinations of signs and symptoms have been shown to be more accurate than individual features alone. Although there are no proven clinical definitions, the following features have been shown to be suggestive of pneumonia:

Tachypnea for age:

Age Respiratory Rate
(breaths/min)
0-2 months 60
2-12 months 50
1-5 years 40
> 5 years 20
  • Fever
  • Hypoxia (oxygen saturation less than or equal to 94%)
  • Retractions and/or nasal flaring
  • Focal rales/crackles

Severity of Pneumonia

Mild Pneumonia
(Outpatient Treatment)		 Moderate Pneumonia
(Inpatient/ICU Treatment)		 Severe Pneumonia
(ICU Treatment)
  • No retractions, grunting, nasal flaring, or apnea
  • Pulse oximetry > 90% in room air
  • Non-toxic appearance
  • Any of the below signs or symptoms:
    • Moderate dyspnea, including:
      • Retractions
      • Grunting
      • Nasal flaring
      • Apnea
    • Pulse oximetry < 90% in room air
    • Need for HFNC (HFNC Guidelines) or other non-invasive mechanical ventilation not meeting severe criteria
  • Any of the below signs or symptoms:
    • Hypoxemic or hypercarbic respiratory failure requiring invasive mechanical ventilation or non-invasive mechanical ventilation with high (e.g., > 40%) or escalating FiO2 requirement attributable to bacterial pneumonia
    • Systemic signs of inadequate perfusion (change in mental status, hemodynamic instability) – Review Sepsis Pathway

Treatment failure is defined as > 48 hours of preferred first-line therapy in a patient that tolerated the regimen with increasing respiratory distress, increasing respiratory support requirement or worsening fever curve.