Clinical pulmonary infection score calculator in the early diagnosis and treatment of ventilator-associated pneumonia in the ICU
© Celik et al.; licensee BioMed Central Ltd. 2014
Published: 17 March 2014
Ventilator-associated pneumonia (VAP) is a frequently occurring nosocomial infection in ICU patients and has been associated with increased morbidity, prolonged duration of ventilation and ICU stay and increased costs for healthcare. It was shown that early diagnosis of VAP and immediate initiation of appropriate antibiotics is associated with reduced morbidity and mortality. The aim of this study is to evaluate the potential ability of a screening test based on the clinical pulmonary infection score (CPIS) to identify and treat patients with VAP.
All files belonging to patients between 18 and 80 years old admitted to the ICU and supported by mechanical ventilation for longer than 48 hours were evaluated retrospectively. Demographic data of the patients, the time of mechanical ventilation, duration of the ICU stay and results (survival or death) were recorded. The CPIS was calculated after 48 hours for the diagnosis of VAP. The patients with CPIS >5 intubated were evaluated VAP(+) and the others with CPIS ≤5 were thought VAP(−). The diagnosis of VAP was bacteriologically confirmed with the culture of endotracheal aspirate. Statistical evaluations were done according to the results on the day of intubation and the results on days 2, 3, 5, 8 and 10 after intubation. Scores of APACHE II and CRP levels were also recorded on the same days.
The duration of mechanical ventilation and ratio of death were significantly higher in the patients with VAP(+). CPIS levels in the patients with VAP(+) were significantly higher than the patients with VAP(−) in the days after the diagnosis. CPIS levels were also higher in the patients with VAP(+) on the day of diagnosis. At the same day the parameters, which included the CPIS, body temperature, leukocyte number, tracheal secretions, PaO2/FiO2 levels and the presence of infiltrates on the chest radiograph, were significantly higher in VAP(+) patients (P < 0.05). ROC curves were formed for CPIS scores to be used in diagnosis VAP and the cutoff point had a sensitivity of 97.44% and a specificity of 100% for diagnosing VAP.
At the end of the study, it was concluded that using the CPIS for early diagnosis and treatment of VAP and thinking that the patients with CPIS >5 were VAP(+) are guiding factors to resolve the problems associated with VAP in ICU patients.
This article is published under license to BioMed Central Ltd. This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2014 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2014. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.