PMC:7386785 / 74140-76702 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7386785","sourcedb":"PMC","sourceid":"7386785","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7386785","text":"Appendix 1. World Health Organization case definitions\n\nSevere pneumonia\nAdolescent or adult: fever or suspected respiratory infection, plus one of the following: respiratory rate \u003e 30 breaths/minute; severe respiratory distress; or oxygen saturation (SpO2) ≤ 93% on room air. Child with cough or difficulty in breathing, plus at least one of the following: central cyanosis or SpO2 \u003c 90%; severe respiratory distress (for example, grunting, very severe chest indrawing); signs of pneumonia with a general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions.\nOther signs of pneumonia may be present: chest indrawing, fast breathing (in breaths/minute): aged \u003c 2 months: ≥ 60; aged 2 to 11 months: ≥ 50; aged 1 to 5 years: ≥ 40. While the diagnosis is made on clinical grounds; chest imaging may identify or exclude some pulmonary complications.\n\nAcute respiratory distress syndrome (ARDS)\nOnset within one week of a known clinical insult or new or worsening respiratory symptoms.\nChest imaging (that is, X‐ray, computed tomography scan, or lung ultrasound): bilateral opacities, not fully explained by volume overload, lobar or lung collapse, or nodules.\nOrigin of pulmonary infiltrates: respiratory failure not fully explained by cardiac failure or fluid overload. Need objective assessment (for example, echocardiography) to exclude hydrostatic cause of infiltrates/oedema if no risk factor present.\nOxygenation impairment in adults:\nmild acute respiratory distress syndrome (ARDS): 200 mmHg \u003c ratio of arterial oxygen partial pressure/fractional inspired oxygen (PaO2/FiO2) ≤ 300 mmHg (with positive end‐expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) ≥ 5 cmH2O, or non‐ventilated);\nmoderate ARDS: 100 mmHg \u003c PaO2/FiO2 ≤ 200 mmHg (with PEEP ≥ 5 cmH2O, or non‐ventilated);\nsevere ARDS: PaO2/FiO2 ≤ 100 mmHg (with PEEP ≥ 5 cmH2O, or non‐ventilated);\nwhen PaO2 is not available, SpO2/FiO2 ≤ 315 mmHg suggests ARDS (including in non‐ventilated patients).\nOxygenation impairment in children: note OI = Oxygenation Index and OSI = Oxygenation Index using SpO2. Use PaO2‐based metric when available. If PaO2 not available, wean FiO2 to maintain SpO2 ≤ 97% to calculate OSI or SpO2/FiO2 ratio:\nbilevel (non‐invasive ventilation or CPAP) ≥ 5 cmH2O via full‐face mask: PaO2/FiO2 ≤ 300 mmHg or SpO2/FiO2 ≤ 264;\nmild ARDS (invasively ventilated): 4 ≤ OI \u003c 8 or 5 ≤ OSI \u003c 7.5;\nmoderate ARDS (invasively ventilated): 8 ≤ OI \u003c 16 or 7.5 ≤ OSI \u003c 12.3;\nsevere ARDS (invasively ventilated): OI ≥ 16 or OSI ≥ 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