Prognostic role of clinical and laboratory criteria to identify early ventilator-associated pneumonia in brain injury

Chest
Paolo PelosiMichael S Niederman

Abstract

We investigated the role of the clinical pulmonary infection score (CPIS), serum levels of procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) in the detection of patients with early ventilator-associated pneumonia (VAP). Observational study in a university hospital. In 58 patients with severe brain injury receiving mechanical ventilation, CPIS, PCT, CRP and SAA were evaluated at ICU entry and at days 3 to 4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or BAL cultures). We found the following: (1) PCT at entry was increased in patients who later had early VAP develop (25 patients) compared to no VAP (median, 1.4 ng/mL; 25-75 percentiles, 0.14-0.78; vs median, 0.2 ng/mL; 25-75 percentiles, 0.76-2.4, p<0.001; sensitivity, 76%; and specificity, 75%); (2) CPIS increased at the day of VAP diagnosis, compared to entry (median, 6.6+/-1.1 vs 1.5+/-1.1, p<0.001; sensitivity, 97%; specificity, 100%), while other serum inflammatory markers did not change; and (3) deterioration in oxygenation and changes in tracheal secretions were the main determinants of CPIS changes. PCT may be a useful marker to predict which patients subsequently have early VAP. The CPIS could help as an early way to dete...Continue Reading

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Citations

Apr 30, 2011·JPEN. Journal of Parenteral and Enteral Nutrition·Norma A MethenyStephen A McClave
Dec 17, 2009·Mediators of Inflammation·Hanssa Summah, Jie-Ming Qu
Jun 19, 2012·Expert Review of Anti-infective Therapy·Matteo BassettiPaolo Pelosi
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Aug 7, 2014·Clinical and Translational Medicine·Ornella Piazza, Xiangdong Wang

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