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Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm?
Background: Ventilator-associated pneumonia (VAP) is associated to longer stay and poor outcomes. Lacking definitive diagnostic criteria, worsening gas exchange assessed by PaO(2)/F(I)O(2) ≤ 240 in mmHg has been proposed as one of the diagnostic criteria for VAP. We aim to assess the adequacy of PaO...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722826/ https://www.ncbi.nlm.nih.gov/pubmed/31416285 http://dx.doi.org/10.3390/jcm8081217 |
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author | Ferrer, Miquel Sequeira, Telma Cilloniz, Catia Dominedo, Cristina Li Bassi, Gianluigi Martin-Loeches, Ignacio Torres, Antoni |
author_facet | Ferrer, Miquel Sequeira, Telma Cilloniz, Catia Dominedo, Cristina Li Bassi, Gianluigi Martin-Loeches, Ignacio Torres, Antoni |
author_sort | Ferrer, Miquel |
collection | PubMed |
description | Background: Ventilator-associated pneumonia (VAP) is associated to longer stay and poor outcomes. Lacking definitive diagnostic criteria, worsening gas exchange assessed by PaO(2)/F(I)O(2) ≤ 240 in mmHg has been proposed as one of the diagnostic criteria for VAP. We aim to assess the adequacy of PaO(2)/F(I)O(2) ≤ 240 to diagnose VAP. Methods: Prospective observational study in 255 consecutive patients with suspected VAP, clustered according to PaO(2)/F(I)O(2) ≤ 240 vs. > 240 at pneumonia onset. The primary analysis was the association between PaO(2)/F(I)O(2) ≤ 240 and quantitative microbiologic confirmation of pneumonia, the most reliable diagnostic gold-standard. Results: Mean PaO(2)/F(I)O(2) at VAP onset was 195 ± 82; 171 (67%) cases had PaO(2)/F(I)O(2) ≤ 240. Patients with PaO(2)/F(I)O(2) ≤ 240 had a lower APACHE-II score at ICU admission; however, at pneumonia onset they had higher CPIS, SOFA score, acute respiratory distress syndrome criteria and incidence of shock, and less microbiological confirmation of pneumonia (117, 69% vs. 71, 85%, p = 0.008), compared to patients with PaO(2)/FIO(2) > 240. In multivariate logistic regression, PaO(2)/FIO(2) ≤ 240 was independently associated with less microbiological confirmation (adjusted odds-ratio 0.37, 95% confidence interval 0.15–0.89, p = 0.027). The association between PaO(2)/F(I)O(2) and microbiological confirmation of VAP was poor, with an area under the ROC curve 0.645. Initial non-response to treatment and length of stay were similar between both groups, while hospital mortality was higher in patients with PaO(2)/F(I)O(2) ≤ 240. Conclusion: Adding PaO(2)/F(I)O(2) ratio ≤ 240 to the clinical and radiographic criteria does not help in the diagnosis of VAP. PaO(2)/F(I)O(2) ratio > 240 does not exclude this infection. Using this threshold may underestimate the incidence of VAP. |
format | Online Article Text |
id | pubmed-6722826 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-67228262019-09-10 Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? Ferrer, Miquel Sequeira, Telma Cilloniz, Catia Dominedo, Cristina Li Bassi, Gianluigi Martin-Loeches, Ignacio Torres, Antoni J Clin Med Article Background: Ventilator-associated pneumonia (VAP) is associated to longer stay and poor outcomes. Lacking definitive diagnostic criteria, worsening gas exchange assessed by PaO(2)/F(I)O(2) ≤ 240 in mmHg has been proposed as one of the diagnostic criteria for VAP. We aim to assess the adequacy of PaO(2)/F(I)O(2) ≤ 240 to diagnose VAP. Methods: Prospective observational study in 255 consecutive patients with suspected VAP, clustered according to PaO(2)/F(I)O(2) ≤ 240 vs. > 240 at pneumonia onset. The primary analysis was the association between PaO(2)/F(I)O(2) ≤ 240 and quantitative microbiologic confirmation of pneumonia, the most reliable diagnostic gold-standard. Results: Mean PaO(2)/F(I)O(2) at VAP onset was 195 ± 82; 171 (67%) cases had PaO(2)/F(I)O(2) ≤ 240. Patients with PaO(2)/F(I)O(2) ≤ 240 had a lower APACHE-II score at ICU admission; however, at pneumonia onset they had higher CPIS, SOFA score, acute respiratory distress syndrome criteria and incidence of shock, and less microbiological confirmation of pneumonia (117, 69% vs. 71, 85%, p = 0.008), compared to patients with PaO(2)/FIO(2) > 240. In multivariate logistic regression, PaO(2)/FIO(2) ≤ 240 was independently associated with less microbiological confirmation (adjusted odds-ratio 0.37, 95% confidence interval 0.15–0.89, p = 0.027). The association between PaO(2)/F(I)O(2) and microbiological confirmation of VAP was poor, with an area under the ROC curve 0.645. Initial non-response to treatment and length of stay were similar between both groups, while hospital mortality was higher in patients with PaO(2)/F(I)O(2) ≤ 240. Conclusion: Adding PaO(2)/F(I)O(2) ratio ≤ 240 to the clinical and radiographic criteria does not help in the diagnosis of VAP. PaO(2)/F(I)O(2) ratio > 240 does not exclude this infection. Using this threshold may underestimate the incidence of VAP. MDPI 2019-08-14 /pmc/articles/PMC6722826/ /pubmed/31416285 http://dx.doi.org/10.3390/jcm8081217 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Ferrer, Miquel Sequeira, Telma Cilloniz, Catia Dominedo, Cristina Li Bassi, Gianluigi Martin-Loeches, Ignacio Torres, Antoni Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? |
title | Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? |
title_full | Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? |
title_fullStr | Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? |
title_full_unstemmed | Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? |
title_short | Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? |
title_sort | ventilator-associated pneumonia and pao(2)/f(i)o(2) diagnostic accuracy: changing the paradigm? |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722826/ https://www.ncbi.nlm.nih.gov/pubmed/31416285 http://dx.doi.org/10.3390/jcm8081217 |
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