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Clinical criteria used in diagnosing ventilator-associated pneumonia |
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| Johanson criteria |
• Presence of a new or progressive radiographic infiltrate |
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| • Plus at least two of three clinical features: |
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| - fever > 38°C |
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| - leukocyto sis or leukopeni |
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| - purulent secretions |
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| • Temperature |
• Oxygenation (PaO2/FiO2) |
• Tracheal secretions (score) |
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| - 0 point: 36.5–38.4 C |
- 0 point: PaO2/FiO2 > 240 or ARDS |
-0 point: < 14 |
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| - 1 point: 38.5–38.9 |
- 2 points: PaO2/FiO2 < 240 and no evidence of ARDS |
-1 point: > 14 |
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| - 2 points: < 36 or > 39 |
-2 points: purulent sputum |
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| Clinical Pulmonary Infection Score (CPIS) |
• Blood leukocytes (cells/μL) |
• Culture of tracheal aspirate |
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| - 0 point: 4000–11000 |
-0 point: minimal or no growth |
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| - 1 point: < 4000 or > 11000 |
-1 point: moderate or more growth |
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| - 2 points: > 500 band forms |
-2 points: moderate or greater growth |
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| • Pulmonary radiography |
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| -0 point: no infiltrate |
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| - 1 point: diffuse or patchy infiltrates |
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| - 2 points: localized infiltrate |
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| Total score of > 6 points suggests ventilator-associated pneumonia |
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| ARDS = acute respiratory distress syndrome |
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| Centers for Disease Control and Prevention (CDC) |
• Radiology signs |
• Clinical signs |
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| Two or more serial chest radiographs with at least 1 of the following: |
At least 1 of the following: |
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| - new or progressi ve and persistent infiltrate |
- fever (temperat ure > 38 C) |
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| - consolidation |
- leukopeni a (< 4000 WBC) or leukocyto sis (> 12000 WBC) |
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| - cavitation |
- altered mental status, for adults 70 years or older, with no other recognized cause |
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| • Microbiological criteria |
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| At least one of the following: |
Plus at least 2 of the following:- |
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| - positive growth in blood culture not related to another source of infection |
- new onset of purulent sputum, or change in character of sputum |
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| - positive growth in culture or pleural field |
- increased respiratory secretions, or increased suctioning requirements |
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| - positive quantitati ve culture from bronchoal veolar lavage (> 104) or protected specimen brushing (> 103) |
- new-onset or worsening cough, or dyspnea, or tachypnea |
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| - five percent or more of cells with intracellul ar bacteria on direct microsco pic examinati on of Gram-stained bronchoal veolar lavage fluid |
- rales or bronchial sounds |
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| - histopathological evidence of pneumonia |
- worsening gas exchange |
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| - increased oxygen requirements |
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Rea-Neto et al. Critical Care 2008 12:R56 doi:10.1186/cc6877 |
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