_id

683a1609c782e11e38d1b150

id

3278

title

Clinical Pulmonary Infection Score (CPIS) for Ventilator-Associated Pneumonia (VAP)

full_title

Clinical Pulmonary Infection Score (CPIS) for Ventilator-Associated Pneumonia (VAP)

short_title

CPIS for VAP

med_description

Assists in diagnosing ventilator-associated pneumonia by predicting benefit of pulmonary cultures.

short_description

Diagnosis of VAP by predicting benefit of pulmonary cultures.

slug

clinical-pulmonary-infection-score-cpis-ventilator-associated-pneumonia-vap

description

The Clinical Pulmonary Infection Score (CPIS) assists in diagnosing ventilator-associated pneumonia (VAP) by predicting benefit of pulmonary cultures.

keywords

cpis, pulm infection, pulmonary infection

complaint

[ "Shortness of Breath" ]

formula

Addition of selected points.

evidence

measurements

[]

information

Scores ≥ 7 may indicate higher likelihood of VAP and need for BAL or mini-BAL.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/14566455", "text": "Schurink CA, Van Nieuwenhoven CA, Jacobs JA, Rozenberg-Arska M, Joore HC, Buskens E, Hoepelman AI, Bonten MJ. Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med. 2004 Feb;30(2):217-24. Epub 2003 Oct 18." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/22743372", "text": "Parks NA, et al. Use of the clinical pulmonary infection score to guide therapy for ventilator-associated pneumonia risks antibiotic overexposure in patients with trauma. J Trauma Acute Care Surg. 2012 Jul;73(1):52-8; discussion 58-9. doi: 10.1097/TA.0b013e31825ac37b." }, { "href": "https://cid.oxfordjournals.org/content/51/Supplement_1/S131.full", "text": "Zilberberg MD, Shorr AF. Ventilator-Associated Pneumonia: The Clinical Pulmonary Infection Score as a Surrogate for Diagnostics and Outcome. Clinical Infectious Diseases 2010; 51(S1):S131–S135." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/12738607", "text": "Fartoukh M, Maitre B, HonoréS, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med. 2003;168(2):173." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/21310117", "text": "Shan J, Chen HL, Zhu JH. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respir Care. 2011 Aug;56(8):1087-94. doi: 10.4187/respcare.01097. Epub 2011 Feb 9." } ], "Validations": [] }

pearls

The CPIS, at a cut-off of >6 points to diagnose ventilator-associated pneumonia (VAP), seems poorly sensitive and specific. The few derivation, validation, and autopsy studies, mostly with small selected cohorts, suggest the score may be inaccurate. However, a reasonable reference standard for defining VAP remains elusive, making this a tricky analysis.

usecase

Patients being evaluated for possible ventilator-associated pneumonia.

reasons

VAP is a tricky diagnosis with many confounders. Using a scoring system may be better than using common clinical gestalt.

next_advice

The CPIS score is based on sensible elements, and the likelihood of VAP does seem to be somewhat higher when scores are >6; however, the utility and role of the score remain unknown.

next_actions

CPIS requires aspirate analysis, gram stain and other important laboratory variables.

next_management

We are unaware of validated management algorithms using the CPIS.

diseases

[ "Coronavirus", "COVID-19", "Pneumonia" ]

input_schema

[ { "conditionality": "", "default": null, "label_en": "<p>Temperature (&deg;C)</p>", "mdcalc_info_concept": null, "name": "temp", "option_fhir_rules": null, "optional": false, "options": [ { "label": "36.5-38.4", "value": 0 }, { "label": "38.5-38.9", "value": 1 }, { "label": "≥39.0 or ≤36.0", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": null, "label_en": "<p>White blood cell count</p>", "mdcalc_info_concept": null, "name": "leuks", "option_fhir_rules": null, "optional": false, "options": [ { "label": "4-11", "value": 0 }, { "label": "<4 or >11", "value": 1 }, { "label": "Either <4 or >11 plus band forms ≥500", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": null, "label_en": "<p>Tracheal secretions</p>", "mdcalc_info_concept": null, "name": "trach", "option_fhir_rules": null, "optional": false, "options": [ { "label": "<14+", "value": 0 }, { "label": "≥14+", "value": 1 }, { "label": "≥14+ plus purulent secretions", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": null, "label_en": "<p>Oxygenation, PaO₂/FiO₂ mm Hg</p>", "mdcalc_info_concept": null, "name": "oxy", "option_fhir_rules": null, "optional": false, "options": [ { "label": ">240 or ARDS", "value": 0 }, { "label": "≤240 and no ARDS", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": null, "label_en": "<p>Pulmonary radiography</p>", "mdcalc_info_concept": null, "name": "pulm", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No infiltrate", "value": 0 }, { "label": "Diffuse or patchy infiltrate", "value": 1 }, { "label": "Localized infiltrate", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": null, "label_en": "<p>Culture of tracheal aspirate specimen</p>", "mdcalc_info_concept": null, "name": "culture", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Pathogenic bacteria cultured ≤1 or no growth", "value": 0 }, { "label": "Pathogenic bacteria cultured >1+", "value": 1 }, { "label": "Pathogenic bacteria cultured >1+ plus same pathogenic bacteria on gram stain >1+", "value": 2 } ], "show_points": true, "tips_en": "Semi-quantitative, 0, 1, 2, or 3+", "type": "radio" } ]

instructions

Many reviews of the CPIS feel it should not be relied on; we include it because of its popularity but caution users to review the data on its utility first.

published

2022-04-21T20:29:14.193Z

purpose

[ "Diagnosis" ]

search_terms

[ "VAP", "culture", "pulm cx", "BAL", "covid", "covid-19", "coronavirus" ]

seo

{ "keywords_en": "cpis, pulm infection, pulmonary infection", "meta_description_en": "The Clinical Pulmonary Infection Score (CPIS) assists in diagnosing ventilator-associated pneumonia (VAP) by predicting benefit of pulmonary cultures." }

specialty

[ "Hospitalist Medicine", "Infectious Disease", "Internal Medicine", "Pulmonology" ]

departments

[ "Infectious", "Respiratory" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 4050, "short_title_en": "DRIP Score", "slug": "drug-resistance-pneumonia-drip-score" }, { "calcId": 324, "short_title_en": "CURB-65 Score", "slug": "curb-65-score-pneumonia-severity" }, { "calcId": 3914, "short_title_en": "SMART-COP Score", "slug": "smart-cop-score-pneumonia-severity" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "infectious", "pulmonology" ]

cleaned_use

[ "Patients being evaluated for possible ventilator-associated pneumonia." ]

pub

false