Detection of ventilator associated pneumonia, using clinical pulmonary infection score (CPIS) in critically ill neurological patients

Abstract

Background: Ventilator associated pneumonia (VAP) remains the most common nosocomial infection in the ICU with a very high morbidity, mortality and cost of treatment. Clinical pulmonary infection score (CPIS) can be used prospectively to diagnosis VAP, so as to initiate early treatment and prevent mortality. Most studies indicate that the CPIS has limited value to diagnose VAP. We conducted a prospective study to detect VAP using CPIS score in neurological patients. Materials and Method: After approval of Ethics Committee, 118 consecutive neurological patients who required ventilatory support for more than 48 hours were studied. CPIS score was calculated every day and when the CPIS score was ≥ 6, mini-BAL was taken by catheter in catheter technique and was analyzed for microorganism. Results: A total of 29 VAP episodes were identified using CPIS (score ≥6) during the study period, of which only 18 patient's tracheal aspirate were positive for microorganism. The incidence rate expressed as the total number of VAP episodes per 1000 ventilation days using CPIS score and tracheal aspirate culture was 36.7(29/789) and 22.87(18/789) respectively in this cohort, but overall our ICU VAP rate in neurological patients using CPIS score and tracheal aspirate culture was 15.19(29/1909) and 9.42(18/1909) respectively. Four patients were found to have early VAP (≤5 days of MV) and rest had late VAP. The most common organism was Acinetobactor Baumanni, followed by Enterobacteracae. Early VAP was caused by Enterobacteracae and Acinetobactor causing late VAP. Conclusion: CPIS score can be a fairly good method to diagnose VAP in critically ill neurological patients, when used reasonably and at the same time can help to restrict unnecessary antibiotic use.

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“…the minimum and maximum scores of MCPIS were 0 and 12, respectively. MCPIS over than 7 was diagnostic for VAP ( 19 ).…”

Apply Four Laboratory Characteristics to Classify Critical Patients With COVID-19 After Admission

“…In addition, the CPIS, a diagnostic algorithm, is mainly applied for ventilator-associated pneumonia and community-acquired pneumonia. Most studies indicated that CPIS had inaccurate sensitivity and speci city [34][35][36][37]. The CPIS was suggested to have high inter-observer variability and is not available for multiple centers study [37,38].…”

Effectiveness of Suction Above Cuff Endotracheal Tube (Sacett) in Preventing Ventilator Associated Pneumonia in Critical Patients in Intensive Care Unit

“…A research by The Canadian Critical Care Trials Group suggests that respondents with the most mechanical ventilators in trauma disease, followed by cardiovascular disease, respiratory disease, and neurological diseases (Group, 2006). Another study stated that most ventilator-installed patients are in cardiovascular system disease (Harde et al, 2013). Another also showed that the most respondents are with cardiovascular system disease (Saragih et al, 2014).…”