104 Chapter 5 Supplementary methods Definition of Intensive Care Unit-acquired pneumonia ICU pneumonia in mechanically ventilated patients Patient should demonstrate the following new onset of symptoms/signs deemed not due to any overt noninfectious causes. a. Radiographic criteria: New or worsening infiltrate consistent with pneumonia on chest X-ray or CT-thorax obtained within 24 hours of the event (diagnosed by a qualified radiologist). AND b. Clinical criteria: At least 2 of the following minor or 1 major respiratory sign or symptom of new onset: Minor criteria: • Systemic signs of infection (one or more of the following): Abnormal temperature (oral or tympanic temperature > 38°C or a core temperature ≥ 38.3°C or hypothermia, defined as a core body temperature of < 35°C), and/or abnormal WBC (WBC count > 10,000 cells/mm3, WBC count < 4500 cells/mm3, or > 15% band neutrophils) • Production of purulent endotracheal secretions • Auscultatory findings consistent with pneumonia/pulmonary consolidation (e.g. rales, rhonchi, bronchial breath sounds, dullness to percussion) Major criteria: Acute changes made in the ventilatory support system to enhance oxygenation, as determined by: • PaO2/FiO2 ratio < 240 mmHg, or • A decrease in PaO2/FiO2 by ≥ 50 mmHg ICU pneumonia in not mechanically ventilated patients Patient should demonstrate the following new onset of symptoms/signs deemed not due to any overt noninfectious causes. a. Radiographic criteria: New or worsening infiltrate consistent with pneumonia on chest X-ray or CT-thorax obtained within 24 hours of the event (diagnosed by qualified radiologist) AND b. Clinical criteria: At least 2 of the following minor or 1 major respiratory signs or symptoms: Minor criteria: • Systemic signs of infection: Abnormal temperature (oral or tympanic temperature > 38°C or a core temperature ≥ 38.3°C or hypothermia, defined as a core body temperature of < 35°C), and/or abnormal WBC (WBC count > 10,000 cells/mm3, WBC count < 4500 cells/mm3, or > 15% band neutrophils) • A new onset of cough (or worsening of cough) • Production of purulent sputum • Physical examination findings consistent with pneumonia/pulmonary consolidation such as auscultatory findings (e.g. rales, rhonchi, bronchial breath sounds), dullness to percussion, or pleuritic chest pain • Dyspnea, tachypnea (respiratory rate > 30 breaths/minute), or hypoxemia defined as:
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