Treatment Protocol for Pneumonia with Probable Sepsis

Immediate Assessment and Triage

The Infectious Diseases Society of America recommends calculating the CURB-65 score to assess the severity of pneumonia, with a score ≥2 mandating hospitalization or intensive home care services 1
The European Respiratory Society suggests assessing for septic shock criteria, including the requirement for vasopressors to maintain MAP ≥65 mmHg despite adequate fluid resuscitation, with or without lactate ≥2 mmol/L 3
The American College of Chest Physicians recommends evaluating for ICU admission if the patient has septic shock requiring vasopressors or acute respiratory failure requiring intubation 1
Minor criteria for severe CAP include respiratory rate >30/min, PaO2/FiO2 ratio <250, multilobar involvement on chest radiograph, confusion, systolic BP <90 mmHg, blood urea nitrogen elevation, and hypothermia 1, 2

The Society of Critical Care Medicine recommends administering at least 30 mL/kg of isotonic crystalloid within the first 3 hours for septic shock resuscitation 3
The American College of Surgeons suggests using normal saline or lactated Ringer's solution and avoiding hypotonic crystalloids, starches, or gelatins 3
The European Society of Intensive Care Medicine recommends monitoring for signs of fluid overload, including increased work of breathing, rales, gallop rhythm, and hepatomegaly 5

The Infectious Diseases Society of America recommends initiating broad-spectrum antibiotics as soon as possible, ideally within the first hour, to cover typical bacterial pathogens, atypical organisms, and Pseudomonas aeruginosa if risk factors are present 1, 6
The American Thoracic Society suggests using beta-lactam plus azithromycin for general ward admission and anti-pseudomonal beta-lactam plus a fluoroquinolone or azithromycin for ICU admission or severe sepsis 1

The Society of Critical Care Medicine recommends continuous vital signs monitoring and monitoring for signs of organ dysfunction, including altered mental status, oliguria, and elevated lactate 3, 8
The American Diabetes Association suggests targeting blood glucose 140-180 mg/dL using protocolized insulin therapy 7
The American College of Chest Physicians recommends providing high-protein, high-calorie diet when able to tolerate oral intake and considering enteral nutrition if unable to eat but gastrointestinal tract is functional 8, 10