This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Ventilator-associated pneumonia (VAP) is a frequent complication in intensive care, but its diagnosis is difficult: fever, secretions and infiltrates on X-ray have many other causes. The Clinical Pulmonary Infection Score (CPIS) was proposed by Jérôme Pugin and colleagues in 1991 to combine six findings into one number.
The six items
| Item | 0 | 1 | 2 |
|---|---|---|---|
| Temperature | 36.5 to 38.4 °C | 38.5 to 38.9 °C | 39 °C or more, or 36 °C or less |
| White blood cells | 4,000 to 11,000/µL | under 4,000 or over 11,000 | same, with 50% or more band forms |
| Tracheal secretions | absent | non-purulent | purulent |
| PaO2/FiO2 | over 240 or ARDS | — | 240 or less without ARDS |
| Chest X-ray | no infiltrate | diffuse or patchy | localized |
| Tracheal aspirate culture | no or rare pathogens | moderate or heavy growth | same bacteria seen on Gram stain |
The total runs from 0 to 12. ARDS scores 0 for oxygenation because the poor gas exchange is then explained by another cause.
Reading the result
- Above 6: VAP is likely.
- 6 or less: VAP is less likely.
The initial CPIS uses the first five items, because the culture takes 48 to 72 hours; the calculator shows it separately. The full score is recalculated when the culture and, in some versions, the progression of the X-ray are known.
Use in practice
A well-known trial by Singh and colleagues in 2000 used a CPIS of 6 or less to stop antibiotics after 3 days in patients with suspected pneumonia and a low probability of infection, which reduced antibiotic use and resistance without worse outcomes. This makes the score a tool for antibiotic stewardship as much as for diagnosis.
Example
A ventilated patient at 38.7 °C (1), with 14,000 white cells (1), purulent secretions (2), PaO2/FiO2 of 180 without ARDS (2) and a localized infiltrate (2) has an initial CPIS of 8, above 6.
Limits
Studies comparing CPIS with lung tissue or quantitative cultures found a modest accuracy, and observers often disagree on the X-ray and the secretions. Many guidelines, including those of the IDSA and ATS, do not recommend using the CPIS alone to diagnose VAP. It supports, but does not replace, clinical judgment and microbiology.