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Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis

The aim was to provide global experts ranking on priorities in diagnostic tools for VAP in clinical practice. A multiple criteria decision analysis (MCDA) was performed to identify diagnosis tools for VAP diagnosis. Priority factors were identified after literature review. An international, multidis...

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Autores principales: Ferreira-Coimbra, João, Ardanuy, Carmen, Diaz, Emili, Leone, Marc, De Pascale, Gennaro, Póvoa, Pedro, Prat-Aymerich, Cristina, Serrano-Garcia, Ricardo, Solé-Violan, Jordi, Zaragoza, Rafael, Rello, Jordi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223949/
https://www.ncbi.nlm.nih.gov/pubmed/31654147
http://dx.doi.org/10.1007/s10096-019-03720-x
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author Ferreira-Coimbra, João
Ardanuy, Carmen
Diaz, Emili
Leone, Marc
De Pascale, Gennaro
Póvoa, Pedro
Prat-Aymerich, Cristina
Serrano-Garcia, Ricardo
Solé-Violan, Jordi
Zaragoza, Rafael
Rello, Jordi
author_facet Ferreira-Coimbra, João
Ardanuy, Carmen
Diaz, Emili
Leone, Marc
De Pascale, Gennaro
Póvoa, Pedro
Prat-Aymerich, Cristina
Serrano-Garcia, Ricardo
Solé-Violan, Jordi
Zaragoza, Rafael
Rello, Jordi
author_sort Ferreira-Coimbra, João
collection PubMed
description The aim was to provide global experts ranking on priorities in diagnostic tools for VAP in clinical practice. A multiple criteria decision analysis (MCDA) was performed to identify diagnosis tools for VAP diagnosis. Priority factors were identified after literature review. An international, multidisciplinary expert panel reviewed variables and ranked diagnostic tools. Experts from ten European hospitals participated. Regarding bedside clinical practices, seven required chest X-ray use in all patients, whereas six reported the use of blood cultures and endotracheal aspirate in all patients. Invasive techniques were routinely performed in seven sites. CRP, PCT, and Gram stains were performed in all patients by 5, 2, and 8, respectively. Impact on patient outcomes, safety, and impact on the decision to start antibiotic therapy were ranked as the top three relevant concerns (7.7/10, 7/10, and 6.9/10, respectively). Chest X-ray was ranked as the most important imaging technique to diagnose VAP (score 251.7). Apart from blood cultures, endotracheal aspirate culture was identified as the main collection method for the microbiological testing (scores of 274.8 and 246.8, respectively). Mini-BAL was the preferred invasive technique with a score of 208. Top three biomarkers were CRP (score 184.3), PCT (181.3), and WBC (166.4). Gram stain (192.5) was prioritized among laboratory diagnostic techniques. Using MCDA, it is recommended to perform a combination of diagnostic techniques including images (chest X-ray), culture of clinical specimens (blood cultures and endotracheal aspirate), and biomarkers (CRP or PCT) for VAP diagnosis at the bedside. Gram stain was ranked as the preferred laboratory technique. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10096-019-03720-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-72239492020-05-15 Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis Ferreira-Coimbra, João Ardanuy, Carmen Diaz, Emili Leone, Marc De Pascale, Gennaro Póvoa, Pedro Prat-Aymerich, Cristina Serrano-Garcia, Ricardo Solé-Violan, Jordi Zaragoza, Rafael Rello, Jordi Eur J Clin Microbiol Infect Dis Original Article The aim was to provide global experts ranking on priorities in diagnostic tools for VAP in clinical practice. A multiple criteria decision analysis (MCDA) was performed to identify diagnosis tools for VAP diagnosis. Priority factors were identified after literature review. An international, multidisciplinary expert panel reviewed variables and ranked diagnostic tools. Experts from ten European hospitals participated. Regarding bedside clinical practices, seven required chest X-ray use in all patients, whereas six reported the use of blood cultures and endotracheal aspirate in all patients. Invasive techniques were routinely performed in seven sites. CRP, PCT, and Gram stains were performed in all patients by 5, 2, and 8, respectively. Impact on patient outcomes, safety, and impact on the decision to start antibiotic therapy were ranked as the top three relevant concerns (7.7/10, 7/10, and 6.9/10, respectively). Chest X-ray was ranked as the most important imaging technique to diagnose VAP (score 251.7). Apart from blood cultures, endotracheal aspirate culture was identified as the main collection method for the microbiological testing (scores of 274.8 and 246.8, respectively). Mini-BAL was the preferred invasive technique with a score of 208. Top three biomarkers were CRP (score 184.3), PCT (181.3), and WBC (166.4). Gram stain (192.5) was prioritized among laboratory diagnostic techniques. Using MCDA, it is recommended to perform a combination of diagnostic techniques including images (chest X-ray), culture of clinical specimens (blood cultures and endotracheal aspirate), and biomarkers (CRP or PCT) for VAP diagnosis at the bedside. Gram stain was ranked as the preferred laboratory technique. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10096-019-03720-x) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2019-10-25 2020 /pmc/articles/PMC7223949/ /pubmed/31654147 http://dx.doi.org/10.1007/s10096-019-03720-x Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2019 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Ferreira-Coimbra, João
Ardanuy, Carmen
Diaz, Emili
Leone, Marc
De Pascale, Gennaro
Póvoa, Pedro
Prat-Aymerich, Cristina
Serrano-Garcia, Ricardo
Solé-Violan, Jordi
Zaragoza, Rafael
Rello, Jordi
Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis
title Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis
title_full Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis
title_fullStr Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis
title_full_unstemmed Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis
title_short Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis
title_sort ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223949/
https://www.ncbi.nlm.nih.gov/pubmed/31654147
http://dx.doi.org/10.1007/s10096-019-03720-x
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