What criteria should I use to determine whether a patient with HAP requires admission to intensive care?

Criteria for Intensive Care Admission in Hospital-Acquired Pneumonia (HAP):

• Admission to intensive care should be considered for patients with hospital-acquired pneumonia who exhibit signs of severe illness such as respiratory failure, septic shock, or multi-organ dysfunction.

• Key clinical indicators include: respiratory rate ≥30 breaths per minute, oxygen saturation <90% on room air, hypotension (systolic <90 mmHg or diastolic ≤60 mmHg), altered mental status (confusion or new disorientation), and inability to eat without assistance.

• Patients with hospital-acquired pneumonia who require invasive or non-invasive mechanical ventilation or vasopressor support should be admitted to intensive care.

• Decisions should also consider comorbidities, frailty, and the trajectory of the illness, with early specialist assessment recommended for deteriorating patients.

In summary, ICU admission for hospital-acquired pneumonia is based on the presence of severe respiratory compromise, hemodynamic instability, altered mental status, and the need for organ support, guided by clinical judgement rather than a formal scoring system.

References: This approach aligns with NICE guidance on pneumonia in adults and clinical practice recommendations emphasizing clinical judgement and severity markers for hospital-acquired pneumonia management ¹,².