ICU · Infectious diseases

Acute severe community-acquired pneumonia: comprehensive ICU pathway (sepsis, ARDS, empiric therapy, corticosteroids)

Also known as Severe CAP · Severe community-acquired pneumonia · ICU pneumonia · CURB-65 · PSI PORT score · IDSA ATS CAP guidelines · Pneumonia sepsis ARDS

Severe CAP is ICU-admitted community-acquired pneumonia. IDSA/ATS 2007 severe-CAP rule (validated by Liapikou in 2102 episodes): 1 major (invasive ventilation or septic shock) or ≥3 of 9 minor criteria. CURB-65 (Lim): urea 7 mmol/L, RR ≥30, SBP <90 or DBP ≤60, confusion, age ≥65 — 30-day mortality 0.7/3.2/3/17/41.5/57% at scores 0–5. Hour-1 antimicrobials in septic shock: 79.9% survival; 7.6% average survival lost per hour over the next 6 h (Kumar). ATS/IDSA 2019 severe-CAP empiric therapy: β-lactam + macrolide OR β-lactam + respiratory fluoroquinolone (not FQ monotherapy). CAPE COD: hydrocortisone 200 mg daily, 28-day death 6.2 vs 11.9%. ATS/IDSA 2019 suggests not routinely using corticosteroids in severe CAP (pre-CAPE COD). Duration: minimum 5 days. Empyema drain if pus, Gram/culture-positive, pH <7.20, loculations, or ≥½ hemithorax (Porcel).

Checked against its sources on 5 Sept 2026