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Ventilator Associated Pneumonia Diagnosis

Purpose: To evaluate a patient with ventilator associated pneumonia using the modified Clinical Pulmonary Infection Score (CPIS) as used by Luna et al.

Description

Luna et al used a modified version of the Clinical Pulmonary Infection Score of Pugin et al (CPIS) to evaluate patients with ventilator-associated pneumonia (VAP). The score can help monitor resolution of the pneumonia and separate patients into risk groups. The authors are from multiple hospitals in Buenos Aires, Argentina, and Winthrop University Hospital in New York.


Parameters:

(1) temperature

(2) blood leukocyte count (WBC count)

(3) tracheal secretions

(4) oxygenation, PaO2 to FIO2 ratio (based on first blood gas reported in the morning)

(5) chest radiograph

 

Differences from the original CPIS (page 677):

(1) tracheal aspirate cultures not evaluated

(2) percent band forms not considered

(3) tracheal secretion reporting is simplified

 

Parameter

Finding

Points

temperature

<= 36.0

2

 

>= 36.1 to <= 38.4°C

0

 

>= 38.5 to <= 38.9°C

1

 

>= 39.0

2

blood leukocyte count

< 4,000 per µL

1

 

>= 4,000 to <= 11,000 per µL

0

 

> 11,000 per µL

1

tracheal secretions

few

0

 

moderate

1

 

large

2

 

purulent

+1

PaO2 to FIO2 ratio

> 240 mm Hg

0

 

presence of ARDS

0

 

<= 240 mm Hg and absence of ARDS

2

chest radiograph

no infiltrate

0

 

patchy infiltrate

1

 

diffuse infiltrate

1

 

localized infiltrate

2

 

where:

• In the original table the 0 point temperature range was >= 36.5 to <= 38.4°C. The temperatures between 36.1 and 36.4 were uncovered. In the text 36.0°C was identified as a breakpoint, so I modified the 0 point range.

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 10

• A patient was potentially worsening if the CPIS was >= 6 on the third or fifth day after onset of the pneumonia. Otherwise the patient was considered potentially improving.

• A patient with CPIS <= 5 on the third or fifth day after onset of pneumonia had a lower mortality, associated with receiving adequate therapy.

• The PaO2 to FIO2 ratio can help separate survivors from nonsurvivors starting on day 3 after onset of the pneumonia.


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Specialty

Objective

ICD-10