CLINICAL

PULMONARY

INFECTION SCORE

Preceptor: dr. Hj. Liliriawati Ananta Kahar Sp. An, KIC

 CHAPTER 1
INTRODUCTION
 BACKGROUND
Ventilator associated pneumonia (VAP) is pneumonia
which develops 48 hours after intubation
in a subject supported by mechanical ventilation without
documented pneumonia.

• VAP occurs 9-27% intubated patients

• VAP  Failure Respiration 20-70%
• International Nosocomial Control Consortium: VAP
occurs 13,6/1000
ventilator based on patient, risk factor, hospital setting.
• VAP  difficult to diagnose  Patient in ICU has
same clinical symptoms.
• There is no strictness in diagnosing VAP
• Diagnosis is based on fever, leukocytosis, purulent
tracheobronchial secretion has a substantially high
sensitivity for VAP, but specificity is low needs
scoring systems CLINICAL PULMONARY
INFECTION SCORE

• This aims to provide information on the comparison

of CPIS use as screening, initial diagnosis, and
specificity and sensitivity of CPIS values in
diagnosing VAP.
CHAPTER 2
THEORIES
 DEFINITION OF VAP

VAP is defined as pneumonia

which occurs 48 hours or more
after a mechanical ventilator is
given.
EPIDEMIOLOGY OF VAP

 The incidence of VAP at Dr. M. Djamil

Hospital in patients using mechanical
ventilation and intubation is 15-59%
 In Guler's study in 2012, from 50
respondents, 68% were male and 32% were
female.
 In Basyigit’s in 2017 had a presentation of
53.5% of men and 46.5% of women. This
shows that VAP is more common in men
PATHOPHYSIOLOGY OF
VAP
VAP is caused by the use of ETT or
tracheostomy which interferes with the
anatomy and physiology of breathing
which results in coughing mechanisms
and disrupted expectoration of phlegm
resulting in difficult expulsion of phlegm
and consequently macroaspiration and
microaspiration in oropharynx.
 DIAGNOSE OF VAP

 The diagnosis of VAP still has no gold standard

 pulmonary infiltrates or infiltrates in the lungs are
progressive which are found in chest X-rays that
occur> 48 hours, leukocytosis (> 12 x 109 / ml), and
have purulent tracheobronchial secretions
 Actually the diagnosis of VAP is quite difficult
because tracheobronchial secretions are always
present in patients who use old mechanical ventilators
and actually these patients do not experience
pneumonia.
 DEFINITION OF CPIS

The CPIS or Clinical Pulmonary

Infection Score is an algorithm for
diagnosing VAP based on clinical
symptoms, radiology, and microbiology.
CPIS which was the scoring system
found by Pugin in 1991. CPIS
demonstrated by Pugin has high
sensitivity and specifications, namely
93% and 100%
 CPIS as screening tool VAP

CPIS diagnose has one main

important indicator
“secretion of trachea”.
There are two techniques to
take swab that is using ETA
and BAL.
 Basyigit, 2017 “the research is focusing
in Bronchoaveolar lavage as tools to take
the secretion of trachea with results show
that CPIS with BAL has 100% sensitivity
and specitivity 23% using >7 indicators of
CPIS” as the guler,2012 “Endotracheal
aspiration as tools with results show 76%
and 80,7% sensitivity and 10% and 17%
specitivity more than 72 hours with 7
indicators of CPIS.
Miller, 2018 study showed that “
BAL has the better quality as tools
because it takes the secretion from
bronchoaveolar less contaminate
than ETA”
It also mentioned about CPIS as
diagnostic tool of time up for
antibiotic treatment .
 CHAPTER 3
CONCLUTION
 Measurement of the CPIS scoring system can help
health workers to diagnose and treat early in
patients with VAP

 There is no significant result in the determination of

VAP early and late onset by using CPIS scoring

 CPIS scoring system uses many parameters to help

diagnose VAP so that a rapid diagnosis can be used
to provide appropriate antibiotics and prevent multi
drug resistance in VAP patients.
THANK YOU