The ventilator-associated pneumonia lung ultrasound score versus clinical pulmonary infection score as prognostic indicators for ventilator-associated pneumonia

Abstract

Purpose
Ventilator-associated pneumonia (VAP) is among the most common hospital-acquired infections in the intensive care unit and is associated with substantial morbidity and mortality. This study aimed to compare the prognostic performance of the VAP Lung Ultrasound Score (VPLUS) with the Clinical Pulmonary Infection Score (CPIS) in predicting persistence of VAP.


Methods
This cross-sectional study included fifty adult patients who were intubated, mechanically ventilated, and subsequently developed VAP ≥ 48 h after ventilation at the Critical Care Department, Kasr-Alainy Hospital, Cairo, Egypt between October 2019 and May 2022. CPIS and VPLUS were assessed on days 1, 2, and 7 following VAP diagnosis.


Results

Both CPIS and VPLUS showed significant increases over time. Median CPIS increased from 4 to 9, and median VPLUS increased from 3 to 6 between day 1 and day 7 (both
p
 < 0.001). Patients who recovered from VAP by day 7 had significantly lower CPIS and VPLUS values at all measured time points compared with those with persistent VAP (
p
 = 0.013, 0.003, 0.002 for CPIS on days 1, 2, and 7; and
p
 = 0.002, 0.001, < 0.001 for VPLUS on days 1, 2, and 7, respectively).



Conclusion
VPLUS demonstrated superior early prognostic performance compared with CPIS on day 1 for predicting persistence of VAP by day 7. As a bedside, radiation-free modality, VPLUS may serve as a valuable tool for early monitoring of VAP progression in critical care settings. Findings should be interpreted considering the single-center design and the small number of patients who recovered by day 7.