- A patient
having severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis or patients
responding to noninvasive management.
- These
patients manifest with:
- Dyspnea, RR ≥ 30/min
- Blood oxygen saturation(SpO2) ≤ 90%,
- Or Arterial
Blood Gas (ABG) PaO2/FiO2 ratio < 300 OR when Kigali definition is used
SpO2/FIO2 <350,
- and/or lung
infiltrates in CT imaging > 50% within 24 to 48 hours;
- CURB-65 score
using confusion, Urea>7mmol/L or abnormal creatinine value, respiratory
rate >30, Blood pressure <90/60, Age >65 can be used to determine
severity of pneumonia.
- CURB-65 score
> 2 indicates severe pneumonia
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- Provide oxygen supplementation for SpO2 target ≥ 92-96% (for
pregnant mother, patients with hemodynamic instability SpO2 target
>92-94%)
- Empiric
antimicrobials should be started after taking specimen for culture and
sensitivity
- For patients
who are severely ill and critical, hospitalized, immunocompromised or with
previous structural lung disorder start an antibiotic.
- Ceftazidime /
Cefepime 2g IV TID +/- Vancomycin 1 gm IV BID
- Ceftriaxone
1gm IV bid is an alternative to ceftazidime / Cefepime but not routinely used
because of the high rate of resistance.
- If there is
no response with the above antibiotics or culture and sensitivity result suggests
it Meropenem (or other available carbapenems) 1g IV q 8hours +/- Vancomycin
1g IV q12 hours can be used.
- When patients
improve and can take PO switch to Amoxicillin- clavulanate as in the management of moderate cases.
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