medical decision support medical decision support
Sign In

The Clinical Pulmonary Infection Score (CPIS) of Pugin et al for Diagnosis of Ventilator-Associated Pneumonia

Purpose: To evaluate a patient for ventilator-associated pneumonia using the Clinical Pulmonary Infection Score of Pugin et al.

Description

The Clinical Pulmonary Infection Score (CPIS), also termed the Pugin Score, was developed to evaluate patients for ventilator-associated pneumonia.


Parameters:

(1) body temperature

(2) white blood cell count

(3) nature of tracheal secretions

(4) oxygenation and ARDS

(5) chest X-ray findings

(6) tracheal secretion Gram stain and culture

 

Parameter

Finding

Points

temperature

>= 36.1°C and <= 38.4°C

0

 

>= 38.5°C and <= 38.9°C

1

 

<= 36°C or >= 39°C

2

blood leukocytes

>= 4,000 and <= 11,000 per µL

0

 

< 4,000 or > 11,000 per µL

1

 

band forms >= 500 per µL

+1

tracheal secretions

daily total for tracheal secretions < 14+

0

 

daily total for tracheal secretions >= 14+

1

 

purulent secretions

+1

oxygenation with PaO2/FIO2

> 240 mm Hg

0

 

presence of ARDS

0

 

<= 240 mm Hg and no evidence ARDS

1

pulmonary radiography

no infiltrate

0

 

diffuse infiltrate

1

 

patchy infiltrate

1

 

localized infiltrate

2

semiquantitative culture of tracheal aspirate

no growth

0

 

<= 1+ pathogenic organisms

0

 

> 1+ pathogenic organism

1

 

same organism seen on Gram stain > 1+

+1

from Table 1, page 1122

 

where:

• Table 1 has >= 36.5° C (97.7°F) given 0 point and <= 36°C (96.8°F) given 2 points, but no assignment for 36.1-36.4°C. I changed the range for 0 points to 36.1-38.4°C.

• Scoring secretions: each endotracheal aspirate is scored for volume from 0 to 4+. The daily total for secretions = SUM(scores for individual aspirates during 24 hours).

• For blood leukocytes, the score for band forms appears to be assigned only when the WBC count is < 4,000 or > 11,000 per µL.

• For tracheal secretions, the score for purulent secretions appears to be assigned only when total daily secretions are > 14+.

• For culture of the tracheal aspirate, the score for Gram stain is only assigned if > 1+ pathogenic organisms are cultured.

 

clinical pulmonary infection score =

= SUM(points for parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 12

• A CPIS > 6 is associated with pneumonia.


To read more or access our algorithms and calculators, please log in or register.

Specialty

Objective

ICD-10