Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Clinical Pulmonary Infection Score (CPIS) evaluates the likelihood of ventilator-associated pneumonia (VAP) by analyzing six clinical factors. Each factor receives a predefined score based on its clinical characteristics, which are then summed to arrive at a total score. This total helps medical professionals assess the risk of VAP.

Here's a breakdown of the scoring criteria:

- Temperature (°C):
  - 36.5-38.4: 0 points
  - 38.5-38.9: 1 point
  - >= 39.0 or <= 36.0: 2 points

- White blood cell count (mm³):
  - 4,000-11,000: 0 points
  - < 4,000 or > 11,000: 1 point
  - < 4,000 or > 11,000 with band forms >= 500: 2 points

- Tracheal secretions:
  - < 14+: 0 points
  - >= 14+: 1 point
  - >= 14+ with purulent secretions: 2 points

- Oxygenation (arterial partial pressure of oxygen/fraction of inspired oxygen):
  - > 240 or adult respiratory distress syndrome: 0 points
  - <= 240 and no adult respiratory distress syndrome: 2 points

- Pulmonary radiography:
  - No infiltrate: 0 points
  - Diffuse or patchy infiltrate: 1 point
  - Localized infiltrate: 2 points

- Culture of tracheal aspirate specimen:
  - Pathogenic bacteria cultured <= 1+ or no growth: 0 points
  - Pathogenic bacteria cultured > 1+: 1 point
  - Pathogenic bacteria cultured > 1+ with the same pathogenic bacteria on Gram stain > 1+: 2 points

To use the CPIS, each clinical parameter is evaluated, and the corresponding scores are added to form a total score ranging from 0 to 12. The interpretation based on the total score is straightforward:

- A score of 0 to 6 suggests that ventilator-associated pneumonia is unlikely.
- A score of 7 or higher indicates that ventilator-associated pneumonia is likely.

This systematic evaluation of clinical data ensures that healthcare professionals can make informed decisions regarding the presence of VAP.

The Clinical Pulmonary Infection Score (CPIS) is a diagnostic tool used specifically in the intensive care unit (ICU) setting to assess the likelihood of ventilator-associated pneumonia (VAP) in patients on mechanical ventilation. The CPIS uses six clinical parameters: temperature, blood leukocyte count, tracheal secretions, oxygenation, radiographic infiltrates, and the culture of tracheal aspirate. Each parameter is scored from 0 to 2, with a higher total score indicating a higher probability of VAP. 

The clinical utility of the CPIS is to aid in the diagnosis of VAP, which can be challenging due to the lack of a definitive diagnostic test. It can also guide the initiation and discontinuation of antibiotic therapy in these patients, thereby reducing the risk of antibiotic resistance.

The CPIS may not be applicable or accurate in patients with conditions that can mimic the signs and symptoms of VAP, such as acute respiratory distress syndrome (ARDS), pulmonary edema, or lung contusion. It should also be used with caution in immunocompromised patients, as they may not exhibit typical signs of infection.

Clinical Pulmonary Infection Score for ventilator-associated pneumonia (CPIS)

The RAPID score calculator is designed to assess the risk of 3-month mortality in patients with pleural infections. It uses five input variables: blood urea nitrogen, age, purulence of pleural fluid, infection source, and serum albumin levels. Each input corresponds to predefined categorical options that are assigned specific numerical scores based on clinical findings, allowing the calculator to estimate the risk level.

The scoring system for each input variable is as follows:

1. Blood Urea Nitrogen:
   - Less than 14 mg/dL [5 mmol/L]: 0 points
   - Between 14-23 mg/dL [5-8 mmol/L]: 1 point
   - Greater than 23 mg/dL [8 mmol/L]: 2 points

2. Age (years):
   - Less than 50: 0 points
   - Between 50-70: 1 point
   - Greater than 70: 2 points

3. Purulence of Pleural Fluid:
   - Purulent: 0 points
   - Non-purulent: 1 point

4. Infection Source:
   - Community-acquired: 0 points
   - Hospital-acquired: 1 point

5. Serum Albumin:
   - Equal to or greater than 2.7 g/dL [27 g/L]: 0 points
   - Less than 2.7 g/dL [27 g/L]: 1 point

To compute the total RAPID score, each input answer is converted into a score using the system outlined above, and the scores are summed together. The maximum possible score is 7, while the minimum possible score is 0. Based on the total score, risk of mortality within 3 months is categorized into one of three levels:

- A total score of 2 or less indicates a low risk of 3-month mortality.
- A total score between 3 and 4 indicates a medium risk of 3-month mortality.
- A total score of 5 or more indicates a high risk of 3-month mortality.

The RAPID score is a clinical calculator used for patients with pleural infection. RAPID stands for Renal function, Age, Purulence, Infection source, and Dietary status. This scoring system is used to predict the mortality risk in patients with pleural infection, helping clinicians to stratify patients based on their risk and guide treatment decisions.

The RAPID score is applicable to patients diagnosed with pleural infection, regardless of the underlying cause. It is not suitable for patients without a confirmed diagnosis of pleural infection or those with pleural effusion due to non-infectious causes. The score may also be less accurate in patients with multiple comorbidities or complex medical histories that could independently affect the variables included in the score.

RAPID score for pleural infection

Ventilator-associated pneumonia

Aminoglycosides

Empiric antibiotic therapy

Patients with ventilator-associated pneumonia due to Pseudomonas aeruginosa

Patients with VAP due to P. aeruginosa

Empiric methicillin-resistant Staphylococcus aureus coverage

Empiric MRSA coverage

Duration of treatment

Colistin

Empiric antipseudomonal coverage

Sputum cultures

Patients with ventilator-associated pneumonia due to extended-spectrum beta-lactamase organisms

Patients with VAP due to ESBL organisms

Patients with ventilator-associated pneumonia due to carbapenem-resistant pathogens

Patients with VAP due to carbapenem-resistant pathogens

Antibiotic dosing

Initiation of antibiotics

Patients with ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus

Patients with VAP due to MRSA

Ventilator-associated pneumonia

Guidelines

Key sources