Diagnostic Modalities for VAP Detection
Study Details
Study Description
Brief Summary
asses diagnostic performance of different methods for detection of ventilator associated pneumonia.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
Ventilator associated pneumonia (VAP) is a common cause of nosocomial infection, that can complicate mechanical ventilation and is related to significant utilization of health-care resources.
The diagnosis of VAP is subjected to considerable interobserver variability. The Centers for Disease Control and Prevention (CDC) definition of VAP uses a combination of clinical, radiographic, and micro-biological criteria for diagnosis, but in the absence of a definite diagnostic test, the accurate diagnosis and treatment of VAP is limited.
The clinical pulmonary infection score (CPIS) was developed to objectively diagnose VAP and assign points on the basis of clinical and radiographic data, but its role in diagnosing pneumonia remains controversial .
Lung ultrasound (LUS) is a simple, non irradiating, noninvasive, cost-effective, bedside technique. It has been successfully applied for monitoring aeration and monitoring antibiotic efficacy in ventilator-associated pneumonia (VAP). However, no scientific evidence is yet available on whether LUS reliably improves the diagnosis of VAP.
Quantitative bacterial cultures of the specimen obtained from the lower airways using bronchoscope were proposed for VAP diagnosis with a cut off value of 104 colony-forming unit/ml. However, microbiological cultures cannot guide the early clinical management of patients with a suspected VAP, as they need at least 24 hours for preliminary results. So, starting antibiotics remains a challenge. Moreover, bronchoscopy is not always easy to perform in hypoxemic patients and not promptly available in all ICUs. Therefore, it can be replaced by tracheal aspirate microbiological samples.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: VAP group patients confirmed diagnosis of VAP with bronchoalveolar lavage |
Diagnostic Test: bronchoalveolar lavage
endobronchial sampling through bronchoscopy
Other Names:
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Experimental: Non VAP group patients confirmed not VAP with bronchoalveolar lavage |
Diagnostic Test: bronchoalveolar lavage
endobronchial sampling through bronchoscopy
Other Names:
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Outcome Measures
Primary Outcome Measures
- To detected diagnostic accuracy of chest ultrasound in VAP. [3 years]
To identify sensitivity and specificity of chest ultrasound in VAP diagnosis
- To detected diagnostic accuracy of protected endotracheal aspirate in VAP. [3 years]
To identify sensitivity and specificity of protected endotracheal aspirate in VAP diagnosis
- To detected diagnostic accuracy of usual endotracheal aspirate in VAP. [3 years]
To identify sensitivity and specificity of usual endotracheal aspirate in VAP diagnosis
- To detected diagnostic accuracy of chest X-ray in VAP. [3 years]
To identify sensitivity and specificity of chest X-ray in VAP diagnosis
Eligibility Criteria
Criteria
Inclusion Criteria:
- All adult patients mechanically ventilated for at least 48 hours in Respiratory ICU were included in the study.
who had:
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Clinically suspected VAP according to simplified Clinical Pulmonary Infectious Score exceeding 6.
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Or new or extension of a radiological image with at least two of the following clinical criteria:
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Body temperature ≥ 38.5 ° C or <36 ° C.
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Leukocytes> 10 * 103 / ml or <4 * 103/ ml or > 10% immature cells (in the absence of other known causes).
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Purulent tracheal secretions.
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Hypoxemia with PaO2 <60 mmHg or a PaO2 / FiO2 <300.
Exclusion Criteria:
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Patients with diagnosis of community acquired pneumonia or hospital acquired pneumonia before starting of mechanical ventilation.
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Patients who are contraindicated for bronchoscopy
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Assiut University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, Girard M, Lu Q, Rouby JJ. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010 Jan;38(1):84-92. doi: 10.1097/CCM.0b013e3181b08cdb.
- Mongodi S, Via G, Girard M, Rouquette I, Misset B, Braschi A, Mojoli F, Bouhemad B. Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia. Chest. 2016 Apr;149(4):969-80. doi: 10.1016/j.chest.2015.12.012. Epub 2015 Dec 22.
- Nair GB, Niederman MS. Ventilator-associated pneumonia: present understanding and ongoing debates. Intensive Care Med. 2015 Jan;41(1):34-48. doi: 10.1007/s00134-014-3564-5. Epub 2014 Nov 27. Review.
- VAP diagnosis