Please use this identifier to cite or link to this item:
http://hdl.handle.net/2445/176455
Title: | Ventilator-Associated Pneumonia and PaO(2)/F(I)O(2) Diagnostic Accuracy: Changing the Paradigm? |
Author: | Ferrer Monreal, Miquel Sequeira, Telma Cillóniz, Catia Dominedò, Cristina Bassi, Gianluigi Li Martín Loeches, Ignacio Torres Martí, Antoni |
Keywords: | Pneumologia Unitats de cures intensives Infeccions nosocomials Pneumology Intensive care units Nosocomial infections |
Issue Date: | 14-Aug-2019 |
Publisher: | MDPI |
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. |
Note: | Reproducció del document publicat a: https://doi.org/10.3390/jcm8081217 |
It is part of: | Journal of Clinical Medicine, 2019, vol. 8, num. 8 |
URI: | http://hdl.handle.net/2445/176455 |
Related resource: | https://doi.org/10.3390/jcm8081217 |
ISSN: | 2077-0383 |
Appears in Collections: | Articles publicats en revistes (Medicina) Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
698283.pdf | 1.78 MB | Adobe PDF | View/Open |
This item is licensed under a Creative Commons License