Resolution of Clinical and Laboratory Abnormalities after Diagnosis of Ventilator-Associated Pneumonia in Trauma Patients

Abstract

Clinical and laboratory abnormalities in critically injured patients with VAP do not resolve as quickly as suggested in the guidelines. Future studies should evaluate new methods to determine the response to antibiotic therapy in critically injured patients with VAP.

Time to clinical stability in patients with ventilator-associated pneumonia due to Methicillin-resistant staphylococcus aureus treated with Linezolid versus Vancomycin: results from the IMPAC-HAP study

“…The number of days to reach clinical stability for both study groups is within the range reported in the literature for time to resolution of symptom, [10][11][12][13][14] and is close to the already wellestablished time to clinical stability of CAP. Early clinical improvement at day 3 to 5 has been used as the primary efficacy endpoint in CAP clinical trials based on recommendations from the Food and Drug Administration.…”

“…In these studies, a fix predetermined value was selected to define resolution, such as PaO 2 /FiO 2 ratio ≥ 250, or negative micro results. [10][11][12][13][14] Meeting these criteria practically defines the time when the particular abnormality is back to normal but fails to define when it is improving. In an attempt to define improvement, we compared WBC count and oxygenation with the values of the prior day and define a level of change that will be considered as improvement.…”

“…On the contrary, fewer studies have been published evaluating patients with VAP and these studies all utilized absolute resolution of the criteria used to define clinical stability. [10][11][12][13][14] Clinical resolution has been described to be between 3 and 10 days depending on the cohort of patients being evaluated. Patients with VAP due to MRSA have a longer time to resolution when compared with patients with VAP due to MSSA or H influenza.…”

Treatment ofAchromobacterVentilator-Associated Pneumonia in Critically Ill Trauma Patients

“…Patient management for suspected VAP followed routine clinical care at the study center using a clinical pathway for VAP that has evolved for over 2 decades. [16][17][18][19][20][21][22][23][24] The pathway was made available to the trauma team in an online handbook and via printed cards. Patients were screened for VAP if they had a new or changing infiltrate on chest radiograph plus at least 2 of the following: abnormal temperature (>38°C or <36°C), abnormal white blood cell count (>10 × 10 3 /mm 3 or <4 × 10 3 /mm 3 , or >10% immature neutrophils), or macroscopically purulent sputum.…”

Screening for Ventilator-Associated Pneumonia in the Surgical Intensive Care Unit: A Single-Institution Analysis of 1,013 Lower Respiratory Tract Cultures

“…The utility of incorporating the results of the gram stain into the CPIS also remains unclear [11]. More recently, the value of CPIS clinical in determining resolution of VAP in trauma patients (and specifically for guiding discontinuation of antibiotics) has also been questioned [13][14][15]. Although the ability of CPIS clinical to distinguish infection from the systemic inflammatory response syndrome is poor, less is known regarding its ability to rule out VAP when low; it is this sensitivity that is most relevant to the aforementioned decisions to both screen and initiate empiric antimicrobial therapy.…”