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BMC Pulmonary Medicine

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Open Access 01-12-2021 | Care | Research article

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

Authors: Farshid Rahimibashar, Andrew C. Miller, Mojtaba H. Yaghoobi, Amir Vahedian-Azimi

Published in: BMC Pulmonary Medicine | Issue 1/2021

Abstract

Background

Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard.

Methods

A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal aspirate cultures (TAC) and serum procalcitonin values were obtained for each patient.

Results

Eighty-five patients were enrolled (VAP 45, controls 40). Using HELICS as the reference standard, the sensitivity and specificity for each of the assessed diagnostic algorithms were: CDC/NHSN (Sensitivity 54.2%; Specificity 100%), CPIS (Sensitivity 68.75%; Specificity 95.23%), Johanson (Sensitivity 67.69%; Specificity 95%). The positive TAC rate was 81.2%. The sensitivity for positive TAC with the serum procalcitonin level > 0.5 ng/ml was 51.8%.

Conclusion

VAP remains a considerable source of morbidity and mortality in modern intensive care units. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS had the greatest comparative diagnostic accuracy, whereas the sensitivity of the CDC/NHSN was only marginally better than a positive TAC plus serum procalcitonin > 0.5 ng/ml. Algorithm accuracy was improved by adding serum procalcitonin > 0.5 ng/ml, but not positive quantitative TAC.

Trial Registration: Not indicated for this study type.

Li Y, Cao X, Ge H, Jiang Y, Zhou H, Zheng W. Targeted surveillance of nosocomial infection in intensive care units of 176 hospitals in Jiangsu province, China. J Hosp Infect. 2018;99(1):36–41. https://doi.org/10.1016/j.jhin.2017.10.009.CrossRefPubMed

Álvarez Lerma F, Sánchez García M, Lorente L, Gordo F, Añón JM, Álvarez J, et al. Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish “Zero-VAP” bundle. Med Intensiva. 2014;38(4):226–36. https://doi.org/10.1016/j.medin.2013.12.007.CrossRefPubMed

Righi E, Aggazzotti G, Ferrari E, Giovanardi C, Busani S, Rinaldi L, et al. Trends in ventilator-associated pneumonia: impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit. Am J Infect Control. 2014;42(12):1312–6. https://doi.org/10.1016/j.ajic.2014.08.009.CrossRefPubMed

Tedja R, Nowacki A, Fraser T, Fatica C, Griffiths L, Gordon S, et al. The impact of multidrug resistance on outcomes in ventilator-associated pneumonia. Am J Infect Control. 2014;42(5):542–5. https://doi.org/10.1016/j.ajic.2013.12.009.CrossRefPubMed

Chen JK-H, Chen T-H, Liu H-E, Kao C-C, Chen CF, Ou T-Y, et al. Bundle care for preventing ventilator-associated pneumonia at a medical center: a preliminary report. J Exp Clin Med. 2014;6(5):157–60. https://doi.org/10.1016/j.jecm.2014.08.003

Fihman V, Messika J, Hajage D, Tournier V, Gaudry S, Magdoud F, et al. Five-year trends for ventilator-associated pneumonia: Correlation between microbiological findings and antimicrobial drug consumption. Int J Antimicrob Agents. 2015;46(5):518–25. https://doi.org/10.1016/j.ijantimicag.2015.07.010.CrossRefPubMed

Hudson JKC, McDonald BJ, MacDonald JC, Ruel MA, Hudson CCC. Impact of subglottic suctioning on the incidence of pneumonia after cardiac surgery: a retrospective observational study. J Cardiothorac Vasc Anesth. 2015;29(1):59–63. https://doi.org/10.1053/j.jvca.2014.04.026.CrossRefPubMed

Mohamed KAE. Compliance with VAP bundle implementation and its effectiveness on surgical and medical sub-population in adult ICU. Egypt J Chest Dis Tuberc. 2014;63(1):9–14. https://doi.org/10.1016/j.ejcdt.2013.10.019.CrossRef

Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: a nine months’ prospective study. Ann Thorac Med. 2007;2(2):52–7. https://doi.org/10.4103/1817-1737.32230.CrossRefPubMedPubMedCentral

10.

Memish ZA, Cunningham G, Oni GA, Djazmati W. The incidence and risk factors of ventilator-associated pneumonia in a Riyadh hospital. Infect Control Hosp Epidemiol. 2000;21(4):271–3. https://doi.org/10.1086/501758.CrossRefPubMed

11.

Rosenthal VD. Device-associated nosocomial infections in limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC). Am J Infect Control. 2008;36(10):S171.e7–12. https://doi.org/10.1016/j.ajic.2008.10.009

12.

Guanche-Garcell H, Requejo-Pino O, Rosenthal VD, Morales-Pérez C, Delgado-González O, Fernández-González D. Device-associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection Control Consortium (INICC) findings. Int J Infect Dis. 2011;15(5):e357–62. https://doi.org/10.1016/j.ijid.2011.02.001.CrossRefPubMed

13.

Melsen WG, Rovers MM, Groenwold RHH, Bergmans DCJJ, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665–71. https://doi.org/10.1016/S1473-3099(13)70081-1.CrossRefPubMed

14.

Sharpe JP, Magnotti LJ, Weinberg JA, Swanson JM, Wood GC, Fabian TC, et al. Impact of pathogen-directed antimicrobial therapy for ventilator-associated pneumonia in trauma patients on charges and recurrence. J Am Coll Surg. 2015;220(4):489–95. https://doi.org/10.1016/j.jamcollsurg.2014.12.016.CrossRefPubMed

15.

Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012;33(3):250–6. https://doi.org/10.1086/664049.CrossRefPubMed

16.

Melsen WG, Rovers MM, Koeman M, Bonten MJM. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med. 2011;39(12):2736–42. https://doi.org/10.1097/CCM.0b013e3182281f33.CrossRefPubMed

17.

Nguile-Makao M, Zahar J-R, Français A, Tabah A, Garrouste-Orgeas M, Allaouchiche B, et al. Attributable mortality of ventilator-associated pneumonia: Respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med. 2010;36(5):781–9. https://doi.org/10.1007/s00134-010-1824-6.CrossRefPubMed

18.

Eom JS, Lee M-S, Chun H-K, Choi HJ, Jung S-Y, Kim Y-S, et al. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. Am J Infect Control. 2014;42(1):34–7. https://doi.org/10.1016/j.ajic.2013.06.023.CrossRefPubMed

19.

Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual patient Saf. 2005;31(5):243–8. https://doi.org/10.1016/s1553-7250(05)31031-2.CrossRefPubMed

20.

Samra SR, Sherif DM, Elokda SA. Impact of VAP bundle adherence among ventilated critically ill patients and its effectiveness in adult ICU. Egypt J Chest Dis Tuberc. 2017;66(1):81–6. https://doi.org/10.1016/j.ejcdt.2016.08.010.CrossRef

21.

Kirtland SH, Corley DE, Winterbauer RH, Springmeyer SC, Casey KR, Hampson NB, et al. The diagnosis of ventilator-associated pneumonia. Chest. 1997;112(2):445–57. https://doi.org/10.1378/chest.112.2.445.CrossRefPubMed

22.

Fabregas N, Torres A, El-Ebiary M, Ramirez J, Hernandez C, Gonzalez J, et al. Histopathologic and microbiologic aspects of ventilator-associated pneumonia. Anesthesiology. 1996;84(4):760–71. https://doi.org/10.1136/thx.54.10.867.CrossRefPubMed

23.

Baselski VS, El-Torky M, Coalson JJ, Griffin JP. The standardization of criteria for processing and interpreting laboratory specimens in patients with suspected ventilator-associated pneumonia. Chest. 1992;102(5):571S-579S. https://doi.org/10.1378/chest.102.5_Supplement_1.571S.CrossRefPubMed

24.

Stewart NI, Cuthbertson BH. The problems diagnosing ventilator-associated pneumonia. J Intens Care Soc. 2009;10(4):266–72.CrossRef

25.

National Healthcare Safety Network. Ventilator Associated Event (VAE). United States Center for Disease Control and Prevention; 2020:1–49. https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf. (Accessed 12/21/2019).

26.

Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143(5 Pt 1):1121–9. https://doi.org/10.1164/ajrccm/143.5_Pt_1.1121.CrossRefPubMed

27.

Hospital in Europe Link for Infection Control through Surveillance (HELICS). Surveillance of Nosocomial Infections in Intensive Care Units. Protocol, Version 6.1. Scientific Institute of Public Health. Brussels; 2004:1–51. https://www.sicsag.scot.nhs.uk/hai/helics_protocol.pdf. (Accessed on 01/18/2020).

28.

Johanson WG, Pierce AK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med. 1972;77(5):701–6. https://doi.org/10.7326/0003-4819-77-5-701.CrossRefPubMed

29.

Miller PR, Meredith JW, Chang MC. Optimal threshold for diagnosis of ventilator-associated pneumonia using bronchoalveolar lavage. J Trauma. 2003;55(2):263–7. https://doi.org/10.1097/01.TA.0000075786.19301.91.CrossRefPubMed

30.

Afify MH, Shaheen EA, El-Dahdouh SS, El-Feky HM. Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP. Egypt J Chest Dis Tuberc. 2016;65(1):113–9. https://doi.org/10.1016/j.ejcdt.2015.08.001.CrossRef

31.

Ramírez-Estrada S, Lagunes L, Peña-López Y, Vahedian-Azimi A, Nseir S, Arvaniti K, et al. Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: The EUVAE study. Intensive Care Med. 2018;44(8):1212–20. https://doi.org/10.1007/s00134-018-5269-7.CrossRefPubMedPubMedCentral

32.

Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European. Eur Respir J. 2017;50(3):1700582. https://doi.org/10.1183/13993003.00582-2017.CrossRefPubMed

33.

Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-111. https://doi.org/10.1093/cid/ciw353.CrossRefPubMedPubMedCentral

34.

White RG, Hakim AJ, Salganik MJ, Spiller MW, Johnston LG, Kerr L, et al. Strengthening the reporting of observational studies in epidemiology for respondent-driven sampling studies: “STROBE-RDS” statement. J Clin Epidemiol. 2015;68(12):1463–71. https://doi.org/10.1016/j.jclinepi.2015.04.002.CrossRefPubMedPubMedCentral

35.

Xie D, Xiong W, Lai R, Liu L, Gan X, Wang X, et al. Ventilator-associated pneumonia in intensive care units in Hubei Province, China: a multicentre prospective cohort survey. J Hosp Infect. 2011;78(4):284–8. https://doi.org/10.1016/j.jhin.2011.03.009.CrossRefPubMed

36.

López-Pueyo MJ, Olaechea-Astigarraga P, Palomar-Martínez M, Insausti-Ordeñana J, Alvarez-Lerma F, ENVIN–HELICS Study Group. Quality control of the surveillance programme of ICU-acquired infection (ENVIN-HELICS registry) in Spain. J Hosp Infect. 2013;84(2):126–31. https://doi.org/10.1016/j.jhin.2013.02.018

37.

Duszyńska W, Barteczko B, Kübler A. Monitoring of nosocomial infections using the HELICS network. Anestezjol Intens Ter. 2008;40(1):17–21.PubMed

38.

Álvarez Lerma F, Carrasco M, Otal JJ, Palomar M, Olaechea P, Peris X, et al. Invasive device-related infections after heart surgery. Med Intensiva. 2013;37(9):584–92. https://doi.org/10.1016/j.medin.2012.12.005.CrossRefPubMed

39.

Bouadma L, Luyt C-E, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375(9713):463–74. https://doi.org/10.1016/S0140-6736(09)61879-1.CrossRefPubMed

40.

Tejerina E, Esteban A, Fernández-Segoviano P, Frutos-Vivar F, Aramburu J, Ballesteros D, et al. Accuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings. J Crit Care. 2010;25(1):62–8. https://doi.org/10.1016/j.jcrc.2009.05.008.CrossRefPubMed

41.

Torres A, El-Ebiary M, Padró L, Gonzalez J, de la Bellacasa JP, Ramirez J, et al. Validation of different techniques for the diagnosis of ventilator-associated pneumonia. Comparison with immediate postmortem pulmonary biopsy. Am J Respir Crit Care Med. 1994;149(2 Pt 1):324–31. https://doi.org/10.1164/ajrccm.149.2.8306025.CrossRefPubMed

42.

Jiao J, Wang M, Zhang J, Shen K, Liao X, Zhou X. Procalcitonin as a diagnostic marker of ventilator-associated pneumonia in cardiac surgery patients. Exp Ther Med. 2015;9(3):1051–7. https://doi.org/10.3892/etm.2015.2175.CrossRefPubMedPubMedCentral

43.

Fàbregas N, Ewig S, Torres A, El-Ebiary M, Ramirez J, de La Bellacasa JP, et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax. 1999;54(10):867–73. https://doi.org/10.1136/thx.54.10.867.CrossRefPubMedPubMedCentral

44.

Jamaati HR, Malekmohammad M, Hashemian MR, Nayebi M, Barsharzad N. Ventilator-associated pneumonia: evaluation of etiology, microbiology and resistance patterns in a tertiary respiratory center. Tanaffos. 2010;9(1):21–7.

45.

Chittawatanarat K, Jaipakdee W, Chotirosniramit N, Chandacham K, Jirapongcharoenlap T. Microbiology, resistance patterns, and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit. Infect Drug Resist. 2014;7:203–10. https://doi.org/10.2147/IDR.S67267.CrossRefPubMedPubMedCentral

46.

Bloos F, Marshall JC, Dellinger RP, Vincent J-L, Gutierrez G, Rivers E, et al. Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study. Crit Care. 2011;15(2):R88. https://doi.org/10.1186/cc10087.CrossRefPubMedPubMedCentral

47.

Karhu J, Ala-Kokko TI, Ylipalosaari P, Ohtonen P, Laurila JJ, Syrjala H. Hospital and long-term outcomes of ICU-treated severe community- and hospital-acquired, and ventilator-associated pneumonia patients. Acta Anaesthesiol Scand. 2011;55(10):1254–60. https://doi.org/10.1111/j.1399-6576.2011.02535.x.CrossRefPubMed

48.

Hedrick TL, Smith RL, McElearney ST, Evans HL, Smith PW, Pruett TL, et al. Differences in early- and late-onset ventilator-associated pneumonia between surgical and trauma patients in a combined surgical or trauma intensive care unit. J Trauma Inj Infect Crit Care. 2008;64(3):714–20. https://doi.org/10.1097/TA.0b013e31811ec18e.CrossRef

49.

Vallés J, Pobo A, García-Esquirol O, Mariscal D, Real J, Fernández R. Excess ICU mortality attributable to ventilator-associated pneumonia: the role of early vs late onset. Intensive Care Med. 2007;33(8):1363–8. https://doi.org/10.1007/s00134-007-0721-0.CrossRefPubMed

50.

Giard M, Lepape A, Allaouchiche B, Guerin C, Lehot J-J, Robert M-O, et al. Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit: comparison of risk factors. J Crit Care. 2008;23(1):27–33. https://doi.org/10.1016/j.jcrc.2007.08.005.CrossRefPubMed

51.

Restrepo MI, Peterson J, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care. 2013;58(7):1220–5. https://doi.org/10.4187/respcare.02173.CrossRefPubMedPubMedCentral

52.

Pawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N. Ventilator-associated pneumonia: incidence, risk factors, outcome, and microbiology. J Cardiothorac Vasc Anesth. 2003;17(1):22–8. https://doi.org/10.1053/jcan.2003.4.CrossRefPubMed

53.

Japoni A, Vazin A, Davarpanah MA, Afkhami Ardakani M, Alborzi A, Japoni S, et al. Ventilator-associated pneumonia in Iranian intensive care units. J Infect Dev Ctries. 2011;5(04):286–93. https://doi.org/10.3855/jidc.1212.CrossRefPubMed

54.

Parker CM, Kutsogiannis J, Muscedere J, Cook D, Dodek P, Day AG, et al. Ventilator-associated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: prevalence, incidence, risk factors, and outcomes. J Crit Care. 2008;23(1):18–26. https://doi.org/10.1016/j.jcrc.2008.02.001.CrossRefPubMed

55.

Sundar KM, Nielsen D, Sperry P. Comparison of ventilator-associated pneumonia (VAP) rates between different ICUs: implications of a zero VAP rate. J Crit Care. 2012;27(1):26–32. https://doi.org/10.1016/j.jcrc.2011.05.019.CrossRefPubMed

56.

Giantsou E, Liratzopoulos N, Efraimidou E, Panopoulou M, Alepopoulou E, Kartali-Ktenidou S, et al. Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria. Intensive Care Med. 2005;31(11):1488–94. https://doi.org/10.1007/s00134-005-2697-y.CrossRefPubMed

57.

Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. The occurrence of ventilator-associated pneumonia in a community hospital. Chest. 2001;120(2):555–61. https://doi.org/10.1378/chest.120.2.555.CrossRefPubMed

58.

Rezai MS, Bagheri-Nesami M, Nikkhah A, Bayg AHA. Incidence, risk factors, and outcome of ventilator-associated pneumonia in 18 hospitals of Iran. Int J Adv Biotech Res. 2016;7(3):936–46.

59.

Chouhdari A, Shokouhi S, Bashar FR, Vahedian-Azimi A, Shojaei SP, Fathi M, et al. Is a low incidence rate of ventilation associated pneumonia associated with lower mortality? A descriptive longitudinal study in Iran. Tanaffos. 2018;17(2):110–6.PubMedPubMedCentral

60.

Waltrick R, Possamai DS, de Aguiar FP, Dadam M, Souza Filho VJ, de, Ramos LR, , et al. Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia. Rev Bras Ter Intensiva. 2015;27(3):260–5. https://doi.org/10.5935/0103-507X.20150047.CrossRefPubMedPubMedCentral

61.

Čiginskienė A, Dambrauskienė A, Rello J, Adukauskienė D. Ventilator-associated pneumonia due to drug-resistant Acinetobacter baumannii: risk factors and mortality relation with resistance profiles, and independent predictors of in-hospital mortality. Medicina (B Aires). 2019;55(2):49. https://doi.org/10.3390/medicina55020049.CrossRef

62.

Pham DT, Nguyen TN, Do Q. Researching the changes of serum procalcitonin levels in ventilator-associated pneumonia patients. Mycobact Dis. 2017;07(03):1000246. https://doi.org/10.4172/2161-1068.1000246.CrossRef

63.

Yagmurdur H, Tezcan AH, Karakurt O, Leblebici F. The efficiency of routine endotracheal aspirate cultures compared to bronchoalveolar lavage cultures in ventilator-associated pneumonia diagnosis. Niger J Clin Pract. 2016;19(1):46–51. https://doi.org/10.4103/1119-3077.164327.CrossRefPubMed

64.

Seligman R, Seligman BGS, Konkewicz L, Dos Santos RP. Accuracy of tracheal aspirate gram stain in predicting Staphylococcus aureus infection in ventilator-associated pneumonia. BMC Anesthesiol. 2015;15(1):19. https://doi.org/10.1186/1471-2253-15-19.CrossRefPubMedPubMedCentral

65.

Gürgün A, Korkmaz Ekren P, Bacakoğlu F, Başoğlu OK, Dirican N, Aydemir Ş, et al. The role of endotracheal aspiration in the diagnosis of ventilator associated pneumonia. Tuberk Toraks. 2013;61(4):288–94. https://doi.org/10.5578/tt.6610.CrossRefPubMed

Title: A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study
Authors: Farshid Rahimibashar
Andrew C. Miller
Mojtaba H. Yaghoobi
Amir Vahedian-Azimi
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Care
Pneumonia
Published in: BMC Pulmonary Medicine / Issue 1/2021
Electronic ISSN: 1471-2466
DOI: https://doi.org/10.1186/s12890-021-01527-1

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