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

摘要

Ventilator-Associated Pneumonia (VAP) is a common Healthcare Associated Infection (HAI) incritical care department;VAP occurs frequently and is associated with significant morbidity and mortality incritically 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 ClinicalPulmonary Infection Score (CPIS). Operational research, quasi-experimental interventional study design. Thestudy was conducted in the in critical care department in the Faculty of Medicine Cairo-University. The studyhas 2 phases; Phase 1: recruiting the control group (40 cases) on MV not using CPIS. Phase 2: recruiting theinterventional group (40 cases) on MV using CPIS. The CPIS at day 1 was calculated based on first fivevariables which are temperature, blood leukocyte count, tracheal secretions, oxygenation and character ofpulmonary infiltrate in the X-ray. At day 3 of MV the CPIS was calculated based on all seven variables and tookinto 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?thave pneumonia and antibiotics probably can be stopped. Most of the cases were admitted in both groups dueto Cardiovascular diseases CVS and neurological diseases CNS and the most common cause of ventilation wasDisturbed Conscious Level DCL followed by post arrest cases. The most common organism in control groupwas Klebsiella 25% and in intervention group was MRSA 17.5%. The CPIS was lower in intervention groupat the day 3 with significant difference p = 0.01. Deathsin intervention group (who were followed by CPIS) wereinsignificantly lower. The median of total cost and medication cost were lower in intervention group andthemedian of antibiotic cost was significantly lower in patients (who were followed by CPIS) in interventiongroup than control group p = 0.01. CPIS considered tool to monitor patient?s condition on MV and monitor theirresponse to antibiotic treatment for early modification which in turn reflected on hospital stay and cost.