Clinical pulmonary infection score (CPIS) dynamics in polytrauma patients with ventilator-associated pneumonia

Background

CPIS is an accepted tool for clinical estimation of ventilator-associated pneumonia (VAP), encompassing five components: temperature, blood leukocytes, tracheal secretions, oxygenation index and chest roentgenogram. VAP is considered a frequent complication in mechanically ventilated severe polytrauma patients. There are some current issues that highlight the influence of VAP development on patient mortality [1]. The aim of this study was to evaluate VAP development in severe polytrauma patients according to CPIS criteria and on that basis to determine the patients' clinical course.

Design

A prospective observational study.

Setting

Seventeen-bed trauma intensive care unit.

Methods

Thirty-one severe polytrauma patients (ISS > 26 at admission) requiring mechanical ventilation for more than 3 days who developed VAP were enrolled. We recorded the length of stay of all patients and examined CPIS criteria daily for a period of 10 days after pneumonia occurrence. Patients were divided into subpopulations according to the severity of post-traumatic complications. We calculated the mean 10-day CPIS value for each patient. We considered CPIS > 5 points to be indicative for VAP.

Results

The period that VAP occurred was between the 5th and 8th ventilator day. We observed that the clinical course of VAP depended on the severity of the post-traumatic complications. Patients with no post-traumatic complications had a mean 10-day CPIS value of 4.5. Patients with severe complications had a mean 10-day CPIS value of 5.3, 7.1, 8.1 and 8.4 for patients with single organ failure (survival rate 100%), for patients with pulmonary contusion (survival rate 65%), for patients with severe sepsis (survival rate 26%) and for patients with multiple organ failure syndrome (>2 organs involved, survival rate 17%), respectively. The VAP resolution was shorter in patients with an adequate initial antibiotic therapy.

Conclusion

These data suggest that in the length of 10 days, we could have a precise estimation for the severity of VAP and its dynamics. Mean CPIS values showed good correlation with the degree of post-traumatic complications. CPIC dynamics could serve as a good clinical tool for determination of whether the patient would recover or we might expect a bad outcome.