Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults
Abstract
IDSA/ATS Guidelines for CAP in Adults • CID 2007:44 (Suppl 2) • S31 33.A longer duration of therapy may be needed if initial therapy was not active against the identified pathogen or if it was complicated by extrapulmonary infection, such as meningitis or endocarditis.(Weak recommendation; level III evidence.)Other Treatment Considerations 34.Patients with CAP who have persistent septic shock despite adequate fluid resuscitation should be considered for treatment with drotrecogin alfa activated within 24 h of admission.(Weak recommendation; level II evidence.)35.Hypotensive, fluid-resuscitated patients with severe CAP should be screened for occult adrenal insufficiency.(Moderate recommendation; level II evidence.)36.Patients with hypoxemia or respiratory distress should receive a cautious trial of noninvasive ventilation unless they require immediate intubation because of severe hypoxemia (PaO 2 /FiO 2 ratio, !150) and bilateral alveolar infiltrates.(Moderate recommendation; level I evidence.)37. Low-tidal-volume ventilation (6 cm 3 /kg of ideal body weight) should be used for patients undergoing ventilation who have diffuse bilateral pneumonia or acute respiratory distress syndrome.(Strong recommendation; level I evidence.)Management of Nonresponding Pneumonia Definitions and classification.38.The use of a systematic classification of possible causes of failure to respond, based on time of onset and type of failure (table 11), is recommended.(Moderate recommendation; level…
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