Diagnosis of ventilator-associated pneumonia

Grgurich, Philip; Hudcova, Jana; Y, Lei; Sarwar, Arslan; Craven, Donald E.

doi:10.1097/qco.0b013e32835ebbd0

Cited by 82 publications

(30 citation statements)

References 47 publications

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“…Infectious bacteria obtain direct access to the lower respiratory tract via: (1) micro aspiration, which can occur during intubation itself; (2) development of a biofilm laden with bacteria (typically Gram-negative bacteria and fungal species) within the endotracheal tube; (3) pooling and trickling of secretions around the cuff; and (4) impairment of mucociliary clearance of secretions with gravity dependence of mucus flow within the airways [11-13]. Pathogenic material can also collect in surrounding anatomic structures, such as the stomach, sinuses, nasopharynx and oropharynx, with replacement of normal flora by more virulent strains [11], [12], [14]. This bacterium-enriched material is also constantly thrust forward by the positive pressure exerted by the ventilator.…”

Section: Pathogenesismentioning

confidence: 99%

“…The Gram stain can provide crucial initial clues to the type of organism(s) and whether or not the material is purulent (defined as ≥ 25 neutrophils and ≤ 10 squamous epithelial cells per low power field) [1],[12]. Culture results can be reported as semi-quantitative and/or quantitative values.…”

Section: Diagnosismentioning

confidence: 99%

“…There is poor correlation between radiographic signs (alveolar infiltrates, air bronchograms) and histopathological diagnosis of pneu¬monia [12]. The sensitivity and specificity of presence of infiltrates on chest X-ray is also not encouraging [12]. On the flip-side, the negative predictive value of infiltrates may have clinical utility.…”

Section: Diagnosismentioning

confidence: 99%

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Ventilator-associated pneumonia in the ICU

2014

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Section: Pathogenesismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Ventilator-associated pneumonia in the ICU

2014

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“…Despite the size and prospective design, there are some limitations of the study. First, due to the lack of a globally accepted gold standard for diagnosing VAP (5,6,40), VAP in clinically suspected patients was defined as BALF analysis revealing Ն2% ICOs and/or significant growth (Ն10 4 CFU/ml [41]) of potential pathogenic microorganisms. However, other authors (30,42) suggest other BALF quantitative thresholds, such as Ͼ10 5 CFU/ml.…”

Section: Culturesmentioning

confidence: 99%

Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

et al. 2014

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Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, the results of ETA Gram staining and semiquantitative cultures were compared to the results from a paired ETA-BALF analysis. Different thresholds for the positivity of ETAs were assessed. This was a prospective study of all patients who underwent bronchoalveolar lavage for suspected VAP in a 27-bed university intensive care unit during an 8-year period. VAP was diagnosed when >2% of the BALF cells contained intracellular organisms and/or when BALF quantitative culture revealed >104 CFU/ml of potentially pathogenic microorganisms. ETA Gram staining and semiquantitative cultures were compared to the results from paired BALF analysis by Cohen's kappa coefficients. VAP was suspected in 311 patients and diagnosed in 122 (39%) patients. In 288 (93%) patients, the results from the ETA analysis were available for comparison. Depending on the threshold used and the diagnostic modality, VAP incidences varied from 15% to 68%. For the diagnosis of VAP, the most accurate threshold for positivity of ETA semiquantitative cultures was moderate or heavy growth, whereas the optimal threshold for BALF Gram staining was >1 microorganisms per high power field. The Cohen's kappa coefficients were 0.22, 0.31, and 0.60 for ETA and paired BALF Gram stains, cultures, and BALF Gram stains, respectively. Since the ETA and BALF Gram stains and cultures agreed only fairly, they are probably not interchangeable for diagnosing VAP.

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“…However, there is currently no gold standard for the diagnosis of VAP in the clinical setting [22]. Other limitation is the lack of measurements of sTREM-1 concentrations before surgery to determine the baseline patients’ levels.…”

Section: Discussionmentioning

confidence: 99%

Role of soluble triggering receptor expressed on myeloid cells-1 for diagnosing ventilator-associated pneumonia after cardiac surgery: an observational study

Matsuno

Carlotti

2013

BMC Cardiovasc Disord

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BackgroundThe diagnosis of ventilator-associated pneumonia (VAP) is a challenge, particularly after cardiac surgery. The use of biological markers of infection has been suggested to improve the accuracy of VAP diagnosis. We aimed to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in the diagnosis of VAP following cardiac surgery.MethodsThis was a prospective observational cohort study of children with congenital heart disease admitted to the pediatric intensive care unit (PICU) after surgery and who remained intubated and mechanically ventilated for at least 24 hours postoperatively. VAP was defined by the 2007 Centers for Disease Control and Prevention criteria. Blood, modified bronchoalveolar lavage (mBAL) fluid and exhaled ventilator condensate (EVC) were collected daily, starting immediately after surgery until the fifth postoperative day or until extubation for measurement of sTREM-1.ResultsThirty patients were included, 16 with VAP. Demographic variables, Pediatric Risk of Mortality (PRISM) and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores, duration of surgery and length of cardiopulmonary bypass were not significantly diferent in patients with and without VAP. However, time on mechanical ventilation and length of stay in the PICU and in the hospital were significantly longer in the VAP group. Serum and mBAL fluid sTREM-1 concentrations were similar in both groups. In the VAP group, 12 of 16 patients had sTREM-1 detected in EVC, whereas it was undetectable in all but two patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, specificity 0.86, positive predictive value 0.86, negative predictive value 0.75, positive likelihood ratio (LR) 5.25, negative LR 0.29).ConclusionMeasurement of sTREM-1 in EVC may be useful for the diagnosis of VAP after cardiac surgery.

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Diagnosis of ventilator-associated pneumonia

Cited by 82 publications

References 47 publications

Ventilator-associated pneumonia in the ICU

Ventilator-associated pneumonia in the ICU

Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

Role of soluble triggering receptor expressed on myeloid cells-1 for diagnosing ventilator-associated pneumonia after cardiac surgery: an observational study

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