Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

Pouly, Olivier; Lecailtel, Sylvain; Six, Sophie; Preau, Sébastien; Wallet, Frédéric; Nseir, Saad; Rouzé, Anahita

doi:10.1186/s13613-020-0624-6

Cited by 20 publications

(19 citation statements)

References 21 publications

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“…This result may also be analyzed in regards of the criteria issued by the CDC for the diagnosis of ventilator-associated events, based on the presence of gas exchange worsening [ 10 ]. Even though developed for a purpose of reproducibility, these criteria seem to show a poor agreement with the classical definition of VAP, as outlined by several studies [ 7 , 11 , 12 ]. Our results, showing that severity of hypoxemia exhibited poor accuracy for the diagnosis of VAP tend to support these data.…”

Section: Discussionmentioning

confidence: 96%

Usefulness of Sepsis-3 in diagnosing and predicting mortality of ventilator-associated lower respiratory tract infections

Gaudet

Devos²,

Keignart³

et al. 2021

PLoS ONE

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Background Early distinguishing ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) remains difficult in the daily practice. However, this question appears clinically relevant, as treatments of VAT and VAP currently differ. In this study, we assessed the accuracy of sepsis criteria according to the Sepsis-3 definition in the early distinction between VAT and VAP. Methods Retrospective single-center cohort, including all consecutive patients with a diagnosis of VAT (n = 70) or VAP (n = 136), during a 2-year period. Accuracy of sepsis criteria according to Sepsis-3, total SOFA and respiratory SOFA, calculated at time of microbiological sampling were assessed in differentiating VAT from VAP, and in predicting mortality on ICU discharge. Results Sensitivity and specificity of sepsis criteria were found respectively at 0.4 and 0.91 to distinguish VAT from VAP, and at 0.38 and 0.75 for the prediction of mortality in VA-LRTI. A total SOFA ≥ 6 and a respiratory SOFA ≥ 3 were identified as the best cut-offs for these criteria in differentiating VAT from VAP, with sensitivity and specificity respectively found at 0.63 and 0.69 for total SOFA, and at 0.49 and 0.7 for respiratory SOFA. Additionally, for prediction of mortality, a total SOFA ≥ 7 and a respiratory SOFA = 4 were identified as the best-cut-offs, respectively yielding sensitivity and specificity at 0.56 and 0.61 for total SOFA, and at 0.22 and 0.95 for respiratory SOFA. Conclusions Sepsis criteria according to the Sepsis-3 definition show a high specificity but a low sensitivity for the diagnosis of VAP. Our results do not support the use of these criteria for the early diagnosis of VAP in patients with VA-LRTI.

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Section: Discussionmentioning

confidence: 96%

Usefulness of Sepsis-3 in diagnosing and predicting mortality of ventilator-associated lower respiratory tract infections

Gaudet

Devos²,

Keignart³

et al. 2021

PLoS ONE

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“…However, VAE surveillance is insensitive for identifying VAP 30 . A recent study confirmed that there was poor agreement between VAE and VAP 31 . Therefore, the outcomes of patients with VAE may be different from those with VAP.…”

Section: Discussionmentioning

confidence: 96%

Risk factors and associated outcomes of ventilator-associated events developed in 28 days among sepsis patients admitted to intensive care unit

Fang

Huang

et al. 2020

Sci Rep

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We hypothesized that Ventilator-Associated Event (VAE) within 28 days upon admission to medical intensive care units (ICUs) can be a predictor for poor outcomes in sepsis patients. We aimed to determine the risk factors and associated outcomes of VAE. A total of 453 consecutive mechanically ventilated (MV) sepsis patients were enrolled. Of them, 136 patients had immune profile study. Early VAE (< 7-day MV, n = 33) was associated with a higher mortality (90 days: 81.8% vs. 23.0% [non-VAE], P < 0.01), while late VAE (developed between 7 and 28 days, n = 85) was associated with longer MV day (43.8 days vs. 23.3 days [non-VAE], P < 0.05). The 90-day Kaplan-Meier survival curves showed three lines that separate the groups (non-VAE, early VAE, and late VAE). Cox regression models with time-varying coefficient covariates (adjusted for the number of days from intubation to VAE development) confirmed that VAE which occurred within 28 days upon admission to the medical ICUs can be associated with higher 90-day mortality. The risk factors for VAE development include impaired immune response (lower human leukocyte antigen D-related expression, higher interleukin-10 expression) and sepsis progression with elevated SOFA score (especially in coagulation sub-score). Ventilator-associated event (VAE) 1,2 was proposed to overcome the limitations of only focusing on ventilatorassociated pneumonia (VAP) 3 surveillance in mechanically ventilated (MV) patients in the context of surveying quality improvement. The limitations of previous VAP surveillance, which is proven to be neither sensitive nor specific 4 , hindered its application in quality improvement programs 5. Although VAE surveillance was a promising early warning tool for VAP prevention 6 , VAP prevention bundle compliance was not associated with a reduced risk of VAE 7. VAEs are defined as respiratory deterioration after a period of improved or stable gas exchange. The definition of VAE shifted the focus of surveillance from pneumonia to all conditions caused by mechanical ventilation including infectious or noninfectious conditions. The purpose was to expand the scope of surveillance to include multiple serious complications in ventilated patients, not just pneumonia, as well as to make surveillance more objective, efficient, and suitable for electronic implementation. Sepsis patients developed life-threatening organ dysfunctions (e.g., acute respiratory failure) caused by dysregulated host immune response to infection 8-10. An increase in sequential organ failure assessment (SOFA) score (including respiratory and other five sub-scores) has prognostic accuracy for in-hospital mortality in sepsis patients in the intensive care units (ICUs) 11. Since mechanical ventilator support and aggressive fluid resuscitation

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“…1 ). These cutoff points for the three groups were chosen as a bacterial density of 10 5 ‒10 6 cfu/mL in ETA is frequently used as the threshold for diagnosing VA-LRTI [ 1 , 11 , 12 ]. ETA samples were taken on admission and then once weekly during ICU stay.…”

Section: Methodsmentioning

confidence: 99%

Airway Pseudomonas aeruginosa density in mechanically ventilated patients: clinical impact and relation to therapeutic efficacy of antibiotics

et al. 2021

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Background The bacterial density of Pseudomonas aeruginosa is closely related to its pathogenicity. We evaluated the effect of airway P. aeruginosa density on the clinical course of mechanically ventilated patients and the therapeutic efficacy of antibiotics. Methods We retrospectively analyzed data of mechanically ventilated ICU patients with P. aeruginosa isolated from endotracheal aspirates. Patients were divided into three groups according to the peak P. aeruginosa density during ICU stay: low (≤ 104 cfu/mL), moderate (105‒106 cfu/mL), and high (≥ 107 cfu/mL) peak density groups. The relationship between peak P. aeruginosa density and weaning from mechanical ventilation, risk factors for isolation of high peak density of P. aeruginosa, and antibiotic efficacy were investigated using multivariate and propensity score-matched analyses. Results Four-hundred-and-sixty-one patients were enrolled. Patients with high peak density of P. aeruginosa had higher inflammation and developed more severe respiratory infections. High peak density of P. aeruginosa was independently associated with few ventilator-free days on day 28 (P < 0.01) and increased ICU mortality (P = 0.047). Risk factors for high peak density of P. aeruginosa were prolonged mechanical ventilation (odd ratio [OR] 3.07 95% confidence interval [CI] 1.35‒6.97), non-antipseudomonal cephalosporins (OR 2.17, 95% CI 1.35‒3.49), hyperglycemia (OR 2.01, 95% CI 1.26‒3.22) during ICU stay, and respiratory diseases (OR 1.9, 95% CI 1.12‒3.23). Isolation of commensal colonizer was associated with lower risks of high peak density of P. aeruginosa (OR 0.43, 95% CI 0.26‒0.73). Propensity score-matched analysis revealed that antibiotic therapy for patients with ventilator-associated tracheobronchitis improved weaning from mechanical ventilation only in the high peak P. aeruginosa group. Conclusions Patients with high peak density of P. aeruginosa had worse ventilator outcome and ICU mortality. In patients with ventilator-associated tracheobronchitis, antibiotic therapy was associated with favorable ventilator weaning only in the high peak P. aeruginosa density group, and bacterial density could be a good therapeutic indicator for ventilator-associated tracheobronchitis due to P. aeruginosa.

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Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

Cited by 20 publications

References 21 publications

Usefulness of Sepsis-3 in diagnosing and predicting mortality of ventilator-associated lower respiratory tract infections

Usefulness of Sepsis-3 in diagnosing and predicting mortality of ventilator-associated lower respiratory tract infections

Risk factors and associated outcomes of ventilator-associated events developed in 28 days among sepsis patients admitted to intensive care unit

Airway Pseudomonas aeruginosa density in mechanically ventilated patients: clinical impact and relation to therapeutic efficacy of antibiotics

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