1. Consultant Critical Care medicine, Yashoda Hospital, Hyderabad, India.
3. Resident in Anaesthesiology, Diploma National Board, Yashoda hospital, Hyderabad, India.
4. Consultant respiratory therapy, Yashoda Hospital, Hyderabad, India.
Background: Ventilator associated pneumonia (VAP) remains the most common nosocomial infection in the ICU with a very high morbidity, mortality and cost of treatment. Clinical pulmonary infection score (CPIS) can be used prospectively to diagnosis VAP, so as to initiate early treatment and prevent mortality. Most studies indicate that the CPIS has limited value to diagnose VAP. We conducted a prospective study to detect VAP using CPIS score in neurological patients.
Materials and method: After approval of Ethics Committee, 118 consecutive neurological patients who required ventilatory support for more than 48 hours were studied. CPIS score was calculated every day and when the CPIS score was ≥ 6, mini-BAL was taken by catheter in catheter technique and was analyzed for microorganism.
Results: A total of 29 VAP episodes were identified using CPIS (score ≥6) during the study period, of which only 18 patient's tracheal aspirate were positive for microorganism. The incidence rate expressed as the total number of VAP episodes per 1000 ventilation days using CPIS score and tracheal aspirate culture was 36.7(29/789) and 22.87(18/789) respectively in this cohort, but overall our ICU VAP rate in neurological patients using CPIS score and tracheal aspirate culture was 15.19(29/1909) and 9.42(18/1909) respectively. Four patients were found to have early VAP (≤5 days of MV) and rest had late VAP. The most common organism was Acinetobactor Baumanni, followed by Enterobacteracae. Early VAP was caused by Enterobacteracae and Acinetobactor causing late VAP.
Conclusion: CPIS score can be a fairly good method to diagnose VAP in critically ill neurological patients, when used reasonably and at the same time can help to restrict unnecessary antibiotic use.
Keywords: Ventilator associated pneumonia, clinical pulmonary infection score and neurological patients