Assessment of Efficiency of Using Clinical Pulmonary Infection Score (CPIS) Among Mechanically Ventilated Cases

Abstract

Ventilator-Associated Pneumonia (VAP) is a common Healthcare Associated Infection (HAI) in critical care department; VAP occurs frequently and is associated with significant morbidity and mortality in critically ill patients. This study aimed to improve health outcome of patients on Mechanical Ventilation (MV) through early diagnosis of (VAP), early management with appropriate antibiotics prescription using Clinical Pulmonary Infection Score (CPIS). Operational research, quasi-experimental interventional study design. The study was conducted in the in critical care department in the Faculty of Medicine Cairo-University. The study has 2 phases; Phase 1: recruiting the control group (40 cases) on MV not using CPIS. Phase 2: recruiting the interventional group (40 cases) on MV using CPIS. The CPIS at day 1 was calculated based on first five variables which are temperature, blood leukocyte count, tracheal secretions, oxygenation and character of pulmonary infiltrate in the X-ray. At day 3 of MV the CPIS was calculated based on all seven variables and took into consideration the progression of the infiltrate in chest X-ray and culture results of the tracheal aspirate, a score >6 at baseline or at 72 h is considered suggestive of pneumonia. If < = 6 at 72 h patient probably doesn’t have pneumonia and antibiotics probably can be stopped. Most of the cases were admitted in both groups due to Cardiovascular diseases CVS and neurological diseases CNS and the most common cause of ventilation was Disturbed Conscious Level DCL followed by post arrest cases. The most common organism in control group was Klebsiella 25% and in intervention group was MRSA 17.5%. The CPIS was lower in intervention group at the day 3 with significant difference p = 0.01. Deathsin intervention group (who were followed by CPIS) were insignificantly lower. The median of total cost and medication cost were lower in intervention group and themedian of antibiotic cost was significantly lower in patients (who were followed by CPIS) in intervention group than control group p = 0.01. CPIS considered tool to monitor patient’s condition on MV and monitor their response to antibiotic treatment for early modification which in turn reflected on hospital stay and cost.