The role of endotracheal aspiration in the diagnosis of ventilator associated pneumonia

Gürgün, Alev; Ekren, Pervin Korkmaz; Bacakoğlu, Feza; Başoğlu, Özen K.; Dirican, Nigar; Aydemir, Şöhret; Nart, Denız; Sayıner, Abdullah

doi:10.5578/tt.6610

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…This study was performed in a resource-limited setting in a low-to-middle income country (LMIC) and limiting the study cohort to those with ante-or postmortem histology would have introduced selection bias and served as a barrier for subject recruitment. The use of TAC specimens is a minor limitation as positive quantitative TAC's have been reported to have a high degree of correlation with broncho-alveolar lavage in VAP patients and are a useful minimally invasive diagnostic tool [63][64][65].…”

Section: Limitationsmentioning

confidence: 99%

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

et al. 2021

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Background Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. Methods A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal aspirate cultures (TAC) and serum procalcitonin values were obtained for each patient. Results Eighty-five patients were enrolled (VAP 45, controls 40). Using HELICS as the reference standard, the sensitivity and specificity for each of the assessed diagnostic algorithms were: CDC/NHSN (Sensitivity 54.2%; Specificity 100%), CPIS (Sensitivity 68.75%; Specificity 95.23%), Johanson (Sensitivity 67.69%; Specificity 95%). The positive TAC rate was 81.2%. The sensitivity for positive TAC with the serum procalcitonin level > 0.5 ng/ml was 51.8%. Conclusion VAP remains a considerable source of morbidity and mortality in modern intensive care units. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS had the greatest comparative diagnostic accuracy, whereas the sensitivity of the CDC/NHSN was only marginally better than a positive TAC plus serum procalcitonin > 0.5 ng/ml. Algorithm accuracy was improved by adding serum procalcitonin > 0.5 ng/ml, but not positive quantitative TAC. Trial Registration: Not indicated for this study type.

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Section: Limitationsmentioning

confidence: 99%

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

et al. 2021

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“…The use of TAC specimens is a minor limitation as positive quantitative TAC's have been reported to have a high degree of correlation with bronchoalveolar lavage in VAP patients and are a useful minimally invasive diagnostic tool [41,83,84].…”

Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

“…As compared to immediate post-mortem lung biopsies, clinical criteria have reasonable diagnostic performance but may be highly impacted by the diagnostic thresholds used. For a CPIS threshold ≥6, one meta-analysis reported a pooled sensitivity 73.8% (95% CI 50.6-88.5, low certainty) and speci city of 66.4% (95% CI 43.9-83.3, low certainty) [39][40][41][42]. However, using a CPIS threshold ≥7, the sensitivity and speci city has been reported to be 85% and 91% respectively [43].…”

Section: Introductionmentioning

confidence: 99%

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A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: A prospective observational study

Rahimi–Bashar

Miller

Yaghoobi

et al. 2021

Preprint

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BACKGROUND: Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. METHODS: A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal aspirate cultures (TAC) and serum procalcitonin values were obtained for each patient. RESULTS: Eighty-five patients were enrolled (VAP 44, controls 41). Using HELICS as the reference standard, the respective true positive rate (TPR; sensitivity), true negative rate (TNR; specificity), false positive rate (FPR; fall-out) and false negative rate (FNR; miss-rate) for each of the assessed diagnostic algorithms were: CDC/NHSN (Sensitivity 54.2%; Specificity 100%; FPR 95%; FNR 0%), CPIS (Sensitivity 68.75%; Specificity 95.23%; FPR 50%, FNR 2%), Johanson (Sensitivity 67.69%; Specificity 95%; FPR 52.5%, FNR 2%). The positive TAC rate was 81.2%. The sensitivity for positive TAC with the serum procalcitonin level >0.5 ng/ml was 51.8%. CONCLUSION: VAP remains a considerable source of morbidity and mortality in modern ICUs. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS had the greatest comparative diagnostic accuracy, whereas the sensitivity of the CDC/NHSN was only marginally better than a positive TAC plus serum procalcitonin >0.5 ng/ml. Algorithm accuracy was improved by adding serum procalcitonin >0.5 ng/ml, but not positive quantitative TAC.

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“…However, positive quantitative endotracheal aspirate cultures have been reported to have a high degree of correlation with broncho-alveolar lavage in VAP patients and are a useful minimally invasive diagnostic tool [69][70][71]. Consent (participation & publication): Consent was required and covered both study participation and publication of de-identi ed aggregate ndings.…”

Section: Limitationsmentioning

confidence: 99%

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

Rahimi–Bashar

Miller²,

Yaghoobi

et al. 2020

Preprint

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BACKGROUND: Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. METHODS: A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal cultures and serum procalcitonin values were obtained for each patient. RESULTS: Eighty-five patients were enrolled (VAP 45, controls 41), mean age 46.94±18.9 years with a male predominance (72.94%). Using HELICS as the reference standard, the true positive (TP; sensitivity) and false negative (FN; miss rate) rates were CDC/NHSN (TP 44%; FN 0%), CPIS (TP 43%; FN 1%), Johnson (TP 43%; FN 1%). The highest true negative rate was seen with CPIS. CPIS had the highest Youden index; CDC/NHSN had the lowest. The positive tracheal culture rate was 81.2%. The sensitivity for positive tracheal culture with the serum procalcitonin level >0.5 ng/ml was 51.8%. CDC/NHSN had the highest false positive correlation with tracheal aspirate cultures. CONCLUSION: VAP remains a considerable source of morbidity and mortality in modern ICUs. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS displayed greater diagnostic accuracy compared to CDC/NHSN and Johanson criteria. Accuracy was improved with the addition of serum procalcitonin >0.5 ng/ml, but not positive quantitative endotracheal aspirate culture.TRIAL REGISTRATION: Not indicated for this study type.

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The role of endotracheal aspiration in the diagnosis of ventilator associated pneumonia

Abstract: ÖZET Ventilatörle ilişkili pnömoni tanısında endotrakeal aspiratın değeri Giriş: Ventilatörle ilişkili pnömoni (VİP), yoğun bakım ünitesi (YBÜ)'nde invaziv mekanik ventilasyon (İMV) uygulanan ol

Cited by 6 publications

References 15 publications

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: A prospective observational study

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

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