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Published in: Intensive Care Medicine 1/2010

01-01-2010 | Original

Value of procalcitonin for diagnosis of early onset pneumonia in hypothermia-treated cardiac arrest patients

Authors: Nicolas Mongardon, Virginie Lemiale, Sébastien Perbet, Florence Dumas, Stéphane Legriel, Sylvie Guérin, Julien Charpentier, Jean-Daniel Chiche, Jean-Paul Mira, Alain Cariou

Published in: Intensive Care Medicine | Issue 1/2010

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Abstract

Purpose

Early onset pneumonia is frequently reported after cardiac arrest, despite the fact that therapeutic hypothermia and post-resuscitation disease manifestations make it difficult to diagnose. We aimed to assess the ability of serum procalcitonin (PCT) measurements to help diagnose pneumonia in this setting.

Methods

Retrospective study of consecutive patients admitted to a single academic medical intensive care unit (ICU) for successfully resuscitated cardiac arrest (July 2006–March 2008). All patient files were reviewed to assess the development of pneumonia during the first 5 days of ICU stay. Serum PCT was measured at admission, days (D) 1, 2 and 3.

Results

Among 132 patients included, pneumonia was diagnosed in 86, and antibiotics were initiated in 115 patients during the first 5 days. PCT was significantly higher in patients with pneumonia at D1 (4.58 vs. 1.03 ng/ml, p = 0.017), D2 (3.76 vs. 0.73, p = 0.002) and D3 (3.76 vs. 0.73, p = 0.046). Areas under the ROC curves were 0.59 at admission, 0.64 at D1, 0.68 at D2 and 0.63 at D3. Using a threshold of 0.5 ng/ml, negative predictive values were 39% at admission, 42% at D1 and 52% at D2, whereas positive predictive values were 72, 68 and 70%, respectively. Patients with post-resuscitation shock (n = 66) had significantly higher PCT levels than vasopressor-free patients from D1 to D3.

Conclusions

The diagnostic value of PCT is poor after cardiac arrest and should not be performed to assess early onset pneumonia. The post-resuscitation disease itself could play a major role in this lack of specificity and predictive value.
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Literature
1.
go back to reference Rello J, Vallés J, Jubert P, Ferrer A, Domingo C, Mariscal D, Fontanals D, Artigas A (1995) Lower respiratory tract infections following cardiac arrest and cardiopulmonary resuscitation. Clin Infect Dis 21:310–314PubMed Rello J, Vallés J, Jubert P, Ferrer A, Domingo C, Mariscal D, Fontanals D, Artigas A (1995) Lower respiratory tract infections following cardiac arrest and cardiopulmonary resuscitation. Clin Infect Dis 21:310–314PubMed
2.
go back to reference Gajic O, Festic E, Afessa B (2004) Infectious complications in survivors of cardiac arrest admitted to the medical intensive care unit. Resuscitation 60:65–69CrossRefPubMed Gajic O, Festic E, Afessa B (2004) Infectious complications in survivors of cardiac arrest admitted to the medical intensive care unit. Resuscitation 60:65–69CrossRefPubMed
3.
go back to reference Tsai MS, Chiang WC, Lee CC, Hsieh CC, Ko PC, Hsu CY, Su CP, Chen SY, Chang WT, Yuan A, Ma MH, Chen SC, Chen WJ (2005) Infections in the survivors of out-of-hospital cardiac arrest in the first 7 days. Intensive Care Med 31:621–626CrossRefPubMed Tsai MS, Chiang WC, Lee CC, Hsieh CC, Ko PC, Hsu CY, Su CP, Chen SY, Chang WT, Yuan A, Ma MH, Chen SC, Chen WJ (2005) Infections in the survivors of out-of-hospital cardiac arrest in the first 7 days. Intensive Care Med 31:621–626CrossRefPubMed
5.
go back to reference Adrie C, Laurent I, Monchi M, Cariou A, Dhainaut JF, Spaulding C (2004) Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care 10:208–212CrossRefPubMed Adrie C, Laurent I, Monchi M, Cariou A, Dhainaut JF, Spaulding C (2004) Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care 10:208–212CrossRefPubMed
6.
go back to reference Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J (2004) Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 39:206–217. Erratum in: Clin Infect Dis 2005; 40:1386–1388 Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J (2004) Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 39:206–217. Erratum in: Clin Infect Dis 2005; 40:1386–1388
7.
go back to reference Uzzan B, Cohen R, Nicolas P, Perret GY (2006) Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med 34:1996–2003CrossRefPubMed Uzzan B, Cohen R, Nicolas P, Perret GY (2006) Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med 34:1996–2003CrossRefPubMed
8.
go back to reference Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, Vadas L, Pugin J, Geneva Sepsis Network (2001) Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 164:396–402PubMed Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, Vadas L, Pugin J, Geneva Sepsis Network (2001) Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 164:396–402PubMed
9.
go back to reference Oppert M, Reinicke A, Müller C, Barckow D, Frei U, Eckardt KU (2002) Elevations in procalcitonin but not C-reactive protein are associated with pneumonia after cardiopulmonary resuscitation. Resuscitation 53:167–170CrossRefPubMed Oppert M, Reinicke A, Müller C, Barckow D, Frei U, Eckardt KU (2002) Elevations in procalcitonin but not C-reactive protein are associated with pneumonia after cardiopulmonary resuscitation. Resuscitation 53:167–170CrossRefPubMed
10.
go back to reference Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW, Callaway C, Clark RS, Geocadin RG, Jauch EC, Kern KB, Laurent I, Longstreth WT Jr, Merchant RM, Morley P, Morrison LJ, Nadkarni V, Peberdy MA, Rivers EP, Rodriguez-Nunez A, Sellke FW, Spaulding C, Sunde K, Vanden Hoek T (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation 118:2452–2483CrossRefPubMed Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW, Callaway C, Clark RS, Geocadin RG, Jauch EC, Kern KB, Laurent I, Longstreth WT Jr, Merchant RM, Morley P, Morrison LJ, Nadkarni V, Peberdy MA, Rivers EP, Rodriguez-Nunez A, Sellke FW, Spaulding C, Sunde K, Vanden Hoek T (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation 118:2452–2483CrossRefPubMed
11.
go back to reference Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D’Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, Tibballs J, Timerman S, Truitt T, Zideman D, International Liason Committee on Resusitation (2004) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 63:233–249CrossRefPubMed Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D’Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, Tibballs J, Timerman S, Truitt T, Zideman D, International Liason Committee on Resusitation (2004) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 63:233–249CrossRefPubMed
12.
go back to reference Charles PE, Kus E, Aho S, Prin S, Doise JM, Olsson NO, Blettery B, Quenot JP (2009) Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report. BMC Infect Dis 9:49CrossRefPubMed Charles PE, Kus E, Aho S, Prin S, Doise JM, Olsson NO, Blettery B, Quenot JP (2009) Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report. BMC Infect Dis 9:49CrossRefPubMed
13.
go back to reference Clec’h C, Fosse JP, Karoubi P, Vincent F, Chouahi I, Hamza L, Cupa M, Cohen Y (2006) Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med 34:102–107CrossRefPubMed Clec’h C, Fosse JP, Karoubi P, Vincent F, Chouahi I, Hamza L, Cupa M, Cohen Y (2006) Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med 34:102–107CrossRefPubMed
14.
go back to reference Luyt CE, Combes A, Reynaud C, Hekimian G, Nieszkowska A, Tonnellier M, Aubry A, Trouillet JL, Bernard M, Chastre J (2008) Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med 34:1434–1440CrossRefPubMed Luyt CE, Combes A, Reynaud C, Hekimian G, Nieszkowska A, Tonnellier M, Aubry A, Trouillet JL, Bernard M, Chastre J (2008) Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med 34:1434–1440CrossRefPubMed
15.
go back to reference Amour J, Birenbaum A, Langeron O, Le Manach Y, Bertrand M, Coriat P, Riou B, Bernard M, Hausfater P (2008) Influence of renal dysfunction on the accuracy of procalcitonin for the diagnosis of postoperative infection after vascular surgery. Crit Care Med 36:1147–1154CrossRefPubMed Amour J, Birenbaum A, Langeron O, Le Manach Y, Bertrand M, Coriat P, Riou B, Bernard M, Hausfater P (2008) Influence of renal dysfunction on the accuracy of procalcitonin for the diagnosis of postoperative infection after vascular surgery. Crit Care Med 36:1147–1154CrossRefPubMed
16.
go back to reference Bellomo R, Kellum JA, Ronco C (2007) Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 33:409–413CrossRefPubMed Bellomo R, Kellum JA, Ronco C (2007) Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 33:409–413CrossRefPubMed
17.
go back to reference Müller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, Nusbaumer C, Tamm M, Christ-Crain M (2007) Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 7:10CrossRefPubMed Müller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, Nusbaumer C, Tamm M, Christ-Crain M (2007) Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 7:10CrossRefPubMed
18.
go back to reference Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, Zimmerli W, Harbarth S, Tamm M, Müller B (2006) Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 174:84–93CrossRefPubMed Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, Zimmerli W, Harbarth S, Tamm M, Müller B (2006) Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 174:84–93CrossRefPubMed
19.
go back to reference Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Müller C, Huber P, Müller B, Tamm M (2007) Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 131:9–19CrossRefPubMed Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Müller C, Huber P, Müller B, Tamm M (2007) Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 131:9–19CrossRefPubMed
20.
go back to reference Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J (2008) Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 177:498–505CrossRefPubMed Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J (2008) Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 177:498–505CrossRefPubMed
21.
go back to reference Krüger S, Papassotiriou J, Marre R, Richter K, Schumann C, von Baum H, Morgenthaler NG, Suttorp N, Welte T, CAPNETZ Study Group (2007) Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia: results from the German competence network CAPNETZ. Intensive Care Med 33:2069–2078CrossRefPubMed Krüger S, Papassotiriou J, Marre R, Richter K, Schumann C, von Baum H, Morgenthaler NG, Suttorp N, Welte T, CAPNETZ Study Group (2007) Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia: results from the German competence network CAPNETZ. Intensive Care Med 33:2069–2078CrossRefPubMed
22.
go back to reference Luyt CE, Guérin V, Combes A, Trouillet JL, Ayed SB, Bernard M, Gibert C, Chastre J (2005) Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 171:48–53CrossRefPubMed Luyt CE, Guérin V, Combes A, Trouillet JL, Ayed SB, Bernard M, Gibert C, Chastre J (2005) Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 171:48–53CrossRefPubMed
23.
go back to reference Fries M, Kunz D, Gressner AM, Rossaint R, Kuhlen R (2003) Procalcitonin serum levels after out-of-hospital cardiac arrest. Resuscitation 59:105–109CrossRefPubMed Fries M, Kunz D, Gressner AM, Rossaint R, Kuhlen R (2003) Procalcitonin serum levels after out-of-hospital cardiac arrest. Resuscitation 59:105–109CrossRefPubMed
24.
go back to reference Fries M, Stoppe C, Brücken D, Rossaint R, Kuhlen R (2009) Influence of mild therapeutic hypothermia on the inflammatory response after successful resuscitation from cardiac arrest. J Crit Care 24:453–457CrossRefPubMed Fries M, Stoppe C, Brücken D, Rossaint R, Kuhlen R (2009) Influence of mild therapeutic hypothermia on the inflammatory response after successful resuscitation from cardiac arrest. J Crit Care 24:453–457CrossRefPubMed
25.
go back to reference Adib-Conquy M, Monchi M, Goulenok C, Laurent I, Thuong M, Cavaillon JM, Adrie C (2007) Increased serum levels of soluble triggering receptor expressed on myeloid cells 1 and procalcitonin after cardiac surgery and cardiac arrest without infection. Shock 28:406–410CrossRefPubMed Adib-Conquy M, Monchi M, Goulenok C, Laurent I, Thuong M, Cavaillon JM, Adrie C (2007) Increased serum levels of soluble triggering receptor expressed on myeloid cells 1 and procalcitonin after cardiac surgery and cardiac arrest without infection. Shock 28:406–410CrossRefPubMed
26.
go back to reference Geppert A, Steiner A, Delle-Karth G, Heinz G, Huber K (2003) Usefulness of procalcitonin for diagnosing complicating sepsis in patients with cardiogenic shock. Intensive Care Med 29:1384–1389CrossRefPubMed Geppert A, Steiner A, Delle-Karth G, Heinz G, Huber K (2003) Usefulness of procalcitonin for diagnosing complicating sepsis in patients with cardiogenic shock. Intensive Care Med 29:1384–1389CrossRefPubMed
27.
go back to reference Adrie C, Adib-Conquy M, Laurent I, Monchi M, Vinsonneau C, Fitting C, Fraisse F, Dinh-Xuan AT, Carli P, Spaulding C, Dhainaut JF, Cavaillon JM (2002) Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation 106:562–568CrossRefPubMed Adrie C, Adib-Conquy M, Laurent I, Monchi M, Vinsonneau C, Fitting C, Fraisse F, Dinh-Xuan AT, Carli P, Spaulding C, Dhainaut JF, Cavaillon JM (2002) Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation 106:562–568CrossRefPubMed
28.
go back to reference Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, Bohuon C (1994) Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 79:1605–1608CrossRefPubMed Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, Bohuon C (1994) Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 79:1605–1608CrossRefPubMed
29.
go back to reference Geppert A, Dorninger A, Delle-Karth G, Zorn G, Heinz G, Huber K (2006) Serum concentrations of interleukin-6, organ failure, vasopressor support, and successful coronary revascularization in predicting 30-day mortality of patients with cardiogenic shock complicating acute myocardial infarction. Crit Care Med 34:2035–2042CrossRefPubMed Geppert A, Dorninger A, Delle-Karth G, Zorn G, Heinz G, Huber K (2006) Serum concentrations of interleukin-6, organ failure, vasopressor support, and successful coronary revascularization in predicting 30-day mortality of patients with cardiogenic shock complicating acute myocardial infarction. Crit Care Med 34:2035–2042CrossRefPubMed
30.
go back to reference Tang BM, Eslick GD, Craig JC, McLean AS (2007) Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 7:210–217CrossRefPubMed Tang BM, Eslick GD, Craig JC, McLean AS (2007) Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 7:210–217CrossRefPubMed
31.
go back to reference Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA (2007) Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Ann Emerg Med 50:34–41CrossRefPubMed Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA (2007) Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Ann Emerg Med 50:34–41CrossRefPubMed
32.
go back to reference Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM (1991) Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 143:1121–1129PubMed Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM (1991) Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 143:1121–1129PubMed
33.
go back to reference Luyt CE, Chastre J, Fagon JY (2004) Value of the clinical pulmonary infection score for the identification and management of ventilator-associated pneumonia. Intensive Care Med 30:844–852CrossRefPubMed Luyt CE, Chastre J, Fagon JY (2004) Value of the clinical pulmonary infection score for the identification and management of ventilator-associated pneumonia. Intensive Care Med 30:844–852CrossRefPubMed
34.
go back to reference Schurink CA, Van Nieuwenhoven CA, Jacobs JA, Rozenberg-Arska M, Joore HC, Buskens E, Hoepelman AI, Bonten MJ (2004) Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med 30:217–224CrossRefPubMed Schurink CA, Van Nieuwenhoven CA, Jacobs JA, Rozenberg-Arska M, Joore HC, Buskens E, Hoepelman AI, Bonten MJ (2004) Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med 30:217–224CrossRefPubMed
35.
go back to reference Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30:2126–2168CrossRefPubMed Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30:2126–2168CrossRefPubMed
36.
go back to reference Callaway CW, Rittenberger JC, Logue ES, McMichael MJ (2008) Hypothermia after cardiac arrest does not alter serum inflammatory markers. Crit Care Med 36:2607–2612CrossRefPubMed Callaway CW, Rittenberger JC, Logue ES, McMichael MJ (2008) Hypothermia after cardiac arrest does not alter serum inflammatory markers. Crit Care Med 36:2607–2612CrossRefPubMed
37.
go back to reference Wolfrum S, Radke PW, Pischon T, Willich SN, Schunkert H, Kurowski V (2007) Mild therapeutic hypothermia after cardiac arrest—a nationwide survey on the implementation of the ILCOR guidelines in German intensive care units. Resuscitation 72:207–213CrossRefPubMed Wolfrum S, Radke PW, Pischon T, Willich SN, Schunkert H, Kurowski V (2007) Mild therapeutic hypothermia after cardiac arrest—a nationwide survey on the implementation of the ILCOR guidelines in German intensive care units. Resuscitation 72:207–213CrossRefPubMed
Metadata
Title
Value of procalcitonin for diagnosis of early onset pneumonia in hypothermia-treated cardiac arrest patients
Authors
Nicolas Mongardon
Virginie Lemiale
Sébastien Perbet
Florence Dumas
Stéphane Legriel
Sylvie Guérin
Julien Charpentier
Jean-Daniel Chiche
Jean-Paul Mira
Alain Cariou
Publication date
01-01-2010
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1681-3

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