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DC Field | Value | Language |
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dc.contributor.author | Ferrer Monreal, Miquel | - |
dc.contributor.author | Sequeira, Telma | - |
dc.contributor.author | Cillóniz, Catia | - |
dc.contributor.author | Dominedò, Cristina | - |
dc.contributor.author | Bassi, Gianluigi Li | - |
dc.contributor.author | Martín Loeches, Ignacio | - |
dc.contributor.author | Torres Martí, Antoni | - |
dc.date.accessioned | 2021-04-19T11:24:01Z | - |
dc.date.available | 2021-04-19T11:24:01Z | - |
dc.date.issued | 2019-08-14 | - |
dc.identifier.issn | 2077-0383 | - |
dc.identifier.uri | http://hdl.handle.net/2445/176455 | - |
dc.description.abstract | Background: Ventilator-associated pneumonia (VAP) is associated to longer stay and poor outcomes. Lacking definitive diagnostic criteria, worsening gas exchange assessed by PaO2/FIO2 ≤ 240 in mmHg has been proposed as one of the diagnostic criteria for VAP. We aim to assess the adequacy of PaO2/FIO2 ≤ 240 to diagnose VAP. Methods: Prospective observational study in 255 consecutive patients with suspected VAP, clustered according to PaO2/FIO2 ≤ 240 vs. > 240 at pneumonia onset. The primary analysis was the association between PaO2/FIO2 ≤ 240 and quantitative microbiologic confirmation of pneumonia, the most reliable diagnostic gold-standard. Results: Mean PaO2/FIO2 at VAP onset was 195 ± 82; 171 (67%) cases had PaO2/FIO2 ≤ 240. Patients with PaO2/FIO2 ≤ 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 PaO2/FIO2 > 240. In multivariate logistic regression, PaO2/FIO2 ≤ 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 PaO2/FIO2 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 PaO2/FIO2 ≤ 240. Conclusion: Adding PaO2/FIO2 ratio ≤ 240 to the clinical and radiographic criteria does not help in the diagnosis of VAP. PaO2/FIO2 ratio > 240 does not exclude this infection. Using this threshold may underestimate the incidence of VAP. | - |
dc.format.extent | 13 p. | - |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | MDPI | - |
dc.relation.isformatof | Reproducció del document publicat a: https://doi.org/10.3390/jcm8081217 | - |
dc.relation.ispartof | Journal of Clinical Medicine, 2019, vol. 8, num. 8 | - |
dc.relation.uri | https://doi.org/10.3390/jcm8081217 | - |
dc.rights | cc-by (c) Ferrer Monreal, Miquel et al., 2019 | - |
dc.rights.uri | http://creativecommons.org/licenses/by/3.0/es | - |
dc.source | Articles publicats en revistes (Medicina) | - |
dc.subject.classification | Pneumologia | - |
dc.subject.classification | Unitats de cures intensives | - |
dc.subject.classification | Infeccions nosocomials | - |
dc.subject.other | Pneumology | - |
dc.subject.other | Intensive care units | - |
dc.subject.other | Nosocomial infections | - |
dc.title | Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? | - |
dc.type | info:eu-repo/semantics/article | - |
dc.type | info:eu-repo/semantics/publishedVersion | - |
dc.identifier.idgrec | 698283 | - |
dc.date.updated | 2021-04-19T11:24:01Z | - |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | - |
dc.identifier.pmid | 31416285 | - |
Appears in Collections: | Articles publicats en revistes (Medicina) Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) |
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698283.pdf | 1.78 MB | Adobe PDF | View/Open |
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