Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

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Nonpharmacologic interventions

Therapeutic procedures

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Follow-up and surveillance

Specific circumstances

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Inpatient care

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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

The Arterial Blood Gas Interpreter analyzes three key parameters: arterial pH, partial pressure of carbon dioxide (PaCO₂), and bicarbonate (HCO₃⁻) levels to assess acid-base balance in the body. Here’s how it works:

1. **Input Parameters**
   - Arterial pH: Measures the acidity or alkalinity of the blood. A normal range is between 7.35 and 7.45.
   - PaCO₂: The pressure exerted by carbon dioxide in the blood, typically between 35-45 mmHg. If measured in kPa, it is converted to mmHg by multiplying by 7.5.
   - HCO₃⁻: The concentration of bicarbonate in the blood, with a normal level around 24 mmol/L.

2. **Determine Acid-Base Status**
   - If pH is normal (7.35-7.45), the status is "Normal."
   - If pH is less than 7.35, "Acidosis" is indicated; specific classification depends on PaCO₂ level:
     - If PaCO₂ > 45, it suggests "Respiratory Acidosis."
     - If PaCO₂ <= 45, it suggests "Metabolic Acidosis."
   - If pH is greater than 7.45, "Alkalosis" is indicated; specific classification depends on PaCO₂ level:
     - If PaCO₂ < 35, it suggests "Respiratory Alkalosis."
     - If PaCO₂ >= 35, it suggests "Metabolic Alkalosis."

3. **Calculate Expected Values for Compensation**
   - For "Respiratory Acidosis," expected HCO₃⁻ is 24 + (PaCO₂ - 40) / 10.
   - For "Respiratory Alkalosis," expected HCO₃⁻ is 24 - (40 - PaCO₂) / 5.
   - For "Metabolic Acidosis," expected PaCO₂ is 40 - (24 - HCO₃⁻) * 1.2.
   - For "Metabolic Alkalosis," expected PaCO₂ is 40 + (HCO₃⁻ - 24) * 0.7.

4. **Determine Compensation Level**
   - "Uncompensated" indicates no significant correctional changes.
   - "Partially Compensated" is considered if deviation from expected values is moderate (≤ 5 units).
   - "Fully Compensated" is concluded with minimal deviation (≤ 2 units) from expected values.

5. **Interpretation and Breakdown**
   - The analysis concludes with indicating if there’s an acidosis or alkalosis, its type, and compensation level.
   - Interpretation provides insights, suggesting chronic conditions if compensation is partial or full.
   - A breakdown of calculations includes expected vs. actual values for HCO₃⁻ and PaCO₂.

This interpretation aids healthcare providers in understanding whether the body’s compensatory mechanisms are effectively mitigating the imbalance, helping diagnose underlying conditions like respiratory or metabolic dysfunctions.

The Arterial Blood Gas (ABG) Interpreter analyzes arterial blood gas results, including pH, PaCO₂, and HCO₃⁻, to assess acid-base status, oxygenation, and ventilation. It aids in diagnosing respiratory, metabolic, and mixed acid-base disorders, guiding clinical management in acute and chronic conditions.

Arterial Blood Gas Interpreter

The Acute Physiology and Chronic Health Evaluation II (APACHE II) is a severity-of-disease classification system, specifically designed for critically ill patients admitted to the intensive care unit (ICU). It is a composite score that incorporates 12 physiological variables (including vital signs, arterial blood gas measurements, and serum biochemical parameters), age, and chronic health status. The score ranges from 0 to 71, with higher scores indicating a higher severity of illness and a higher risk of mortality.

The APACHE II score is primarily used to predict ICU mortality, and it can also provide an estimate of ICU length of stay. It is a valuable tool for risk stratification, enabling clinicians to identify patients who may require more intensive monitoring and intervention, and facilitating communication about patient prognosis. 

However, the APACHE II score should not be used in isolation to guide clinical decision-making, as it does not account for all individual patient factors. It is also not applicable to pediatric patients or to patients admitted to the ICU after cardiac surgery, as it was not validated in these populations.

APACHE II