Unifying Concepts

Guidelines for Intensive Care Unit Admission for Severe Community-Acquired Pneumonia (CAP)

The Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recently reviewed risk factors and developed objective major and minor criteria to identify patients who require direct admission to an Intensive Care Unit (ICU). The most up-to-date definitions use need for invasive mechanical ventilation or septic shock, requiring vasopressors, as absolute indicators for direct admission to an ICU. For patients who do not meet either of these two major criteria, minor criteria have been proposed that are based on CURB-65 and ATS criteria with new additions. For admission to an ICU or high level unit, patients must fulfill at least three of these minor criteria.

Criteria for severe community-acquired pneumonia

Major criteria

  • Invasive mechanical ventilation
  • Septic shock with the need for vasopressors

Minor criteria (at least three of these)

  • Respiratory rate ≥ 30 breaths/minute
  • PaO2/FiO2 ratio ≤ 250
  • Multilobar infiltrates
  • New onset confusion/disorientation
  • Uremia (BUN level ≥ 20 mg/dl)
  • Leukopenia (WBC count <4,000 cells/mm3)
  • Thrombocytopenia (platelets <100,000 cells/mm3)
  • Hypothermia (core temperature <36 °C)
  • Hypotension requiring aggressive fluid resuscitation

BUN, blood urea nitrogen; FiO2, fraction of inspired oxygen; PaO2, arterial oxygen tension; WBC, white blood cell.




  1. Rello J. Demographics, guidelines, and clinical experience in severe community-acquired pneumonia. Crit Care. 2008;12 Suppl 6:S2. [Medline]
  2. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. [Medline]
  3. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45–e67. [Medline]


Created Jul 28, 2009
Update Mar 25, 2020

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