Top

Published in:

01-09-2014 | What's New in Intensive Care

Innovations that could improve early recognition of ventilator-associated pneumonia

Authors: Lieuwe D. J. Bos, Ignacio Martin-Loeches, Antonio Artigas

Published in: Intensive Care Medicine | Issue 9/2014

Excerpt

Current diagnostic approaches based on clinical signs and symptoms or using microbiology test results may hamper sufficient recognition of ventilator-associated pneumonia (VAP), since signs and symptoms of VAP are sensitive but non-specific, and microbiology tests are specific but insensitive [1]. But the most important problem, maybe, is that clinicians may always be ‘too late’ using this approach because signs and symptoms of VAP develop days after the true start of the infection and if they eventually trigger the clinician to perform microbiology tests, the results usually become conclusive only after days. Delay in diagnosis of VAP is associated with worse outcome [2]. …

Fàbregas N, Ewig S, Torres A, El-Ebiary M, Ramirez J, de la Bellacasa JP, Bauer T, Cabello H (1999) Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax 54:867–873PubMedCentralPubMedCrossRef

Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH (2002) Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 122:262–268PubMedCrossRef

Gil-Perotin S, Ramirez P, Marti V, Sahuquillo J, Gonzalez E, Calleja I, Menendez R, Bonastre J (2012) Implications of endotracheal tube biofilm in ventilator-associated pneumonia response: a state of concept. Crit Care 16:R93PubMedCentralPubMedCrossRef

Millo JL, Schultz MJ, Williams C, Weverling GJ, Ringrose T, Mackinlay CI, van der Poll T, Garrard CS (2004) Compartmentalisation of cytokines and cytokine inhibitors in ventilator-associated pneumonia. Intensive Care Med 30:68–74PubMedCrossRef

Jiang T, Liu R, Huang X, Feng H, Teo W, Xing B (2009) Colorimetric screening of bacterial enzyme activity and inhibition based on the aggregation of gold nanoparticles. Chem Commun 1972–1974

Rakow NA, Suslick KS (2000) A colorimetric sensor array for odour visualization. Nature 406:710–713PubMedCrossRef

Carey JR, Suslick KS, Hulkower KI, Imlay JA, Imlay KRC, Ingison CK, Ponder JB, Sen A, Wittrig AE (2011) Rapid identification of bacteria with a disposable colorimetric sensing array. J Am Chem Soc 133:7571–7576PubMedCentralPubMedCrossRef

Schultz MJ, Millo J, Levi M, Hack CE, Weverling GJ, Garrard CS, van der Poll T (2004) Local activation of coagulation and inhibition of fibrinolysis in the lung during ventilator associated pneumonia. Thorax 59:130–135PubMedCentralPubMedCrossRef

Conway Morris A, Kefala K, Wilkinson TS, Moncayo-Nieto OL, Dhaliwal K, Farrell L, Walsh TS, Mackenzie SJ, Swann DG, Andrews PJ, Anderson N, Govan JR, Laurenson IF, Reid H, Davidson DJ, Haslett C, Sallenave JM, Simpson AJ (2010) Diagnostic importance of pulmonary interleukin-1beta and interleukin-8 in ventilator-associated pneumonia. Thorax 65:201–207PubMedCentralPubMedCrossRef

10.

Wilkinson TS, Conway Morris A, Kefala K, O’Kane CM, Moore NR, Booth NA, McAuley DF, Dhaliwal K, Walsh TS, Haslett C, Sallenave J-M, Simpson AJ (2012) Ventilator-associated pneumonia is characterized by excessive release of neutrophil proteases in the lung. Chest J 142:1425–1432CrossRef

11.

Bos LDJ, Sterk PJ, Schultz MJ (2013) Volatile metabolites of pathogens: a systematic review. PLoS Pathog 9:e1003311PubMedCentralPubMedCrossRef

12.

Bos LDJ, van Walree IC, Kolk AHJ, Janssen H-G, Sterk PJ, Schultz MJ (2013) Alterations of exhaled breath metabolite-mixtures in two rat models of lipopolysaccharide-induced lung injury. J Appl Physiol 115:1487–1495PubMedCrossRef

13.

Hanson CW III, Thaler ER (2005) Electronic nose prediction of a clinical pneumonia score: biosensors and microbes. Anesthesiology 102:63–68PubMedCrossRef

14.

Bos LDJ, Martin-Loeches I, Kastelijn JB, Gili G, Espasa M, Povoa P, Kolk AHJ, Janssen H-G, Sterk PJ, Artigas A, Schultz MJ (2014) The volatile metabolic fingerprint of ventilator-associated pneumonia. Intensive Care Medicine 40:761–762

Title: Innovations that could improve early recognition of ventilator-associated pneumonia
Authors: Lieuwe D. J. Bos
Ignacio Martin-Loeches
Antonio Artigas
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 9/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3356-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Innovations that could improve early recognition of ventilator-associated pneumonia

Excerpt

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 9/2014

The critical importance of symptoms during and after intensive care

Resistance of Candida spp. to antifungal drugs in the ICU: where are we now?

Comments on Pérez-Bárcena et al.: A randomized trial of intravenous glutamine supplementation in trauma ICU patients

Cardiac arrest after left subclavian venous catheter insertion

Creating my personalized organ donation directive

A data-driven approach to optimized medication dosing: a focus on heparin