Chest Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
First published online on April 10, 2008
Chest, doi:10.1378/chest.07-2546
doi:10.1378/chest.07-2546
(Chest. 2008; 134:101-108)
© 2008 American College of Chest Physicians
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
chest.07-2546v1
134/1/101    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Google Scholar
Right arrow Articles by Pelosi, P.
Right arrow Articles by Niederman, M. S.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pelosi, P.
Right arrow Articles by Niederman, M. S.

Prognostic Role of Clinical and Laboratory Criteria To Identify Early Ventilator-Associated Pneumonia in Brain Injury*

Paolo Pelosi, MD; Alessandra Barassi, MD; Paolo Severgnini, MD; Barbara Gomiero, MD; Sergio Finazzi, MD; Giampaolo Merlini, MD; GianVico Melzi d'Eril, MD; Maurizio Chiaranda, MD and Michael S. Niederman, MD, FCCP

* From Servizio di Anestesia e Rianimazione B (Drs. Pelosi, Severgnini, Gomiero, and Chiaranda), Dipartimento Ambiente Salute e Sicurezza, Università degli Studi dell’Insubria, Varese, Italy; Dipartimento di Medicina, Chirurgia e Odontoiatria (Drs. Barassi and Melzi d’Eril), Università degli Studi di Milano, Milano, Italy; Laboratorio di Analisi (Dr. Finazzi), Ospedale di Legnano, Legnano, Italy; Laboratorio di Biotecnologie (Dr. Merlini), IRCCS Policlinico S. Matteo, Dipartimento di Biochimica, Università degli Studi di Pavia, Pavia, Italy; and Department of Medicine (Dr. Niederman), Winthrop University Hospital, Mineola, NY.

Correspondence to: Paolo Pelosi, MD, Servizio di Anestesia B, Ospedale di Circolo e Fondazione Macchi, viale Borri 57, 21100, Varese, Italy; e-mail: ppelosi{at}hotmail.com

Abstract

Background: We investigated the role of the clinical pulmonary infection score (CPIS), serum levels of procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) in the detection of patients with early ventilator-associated pneumonia (VAP).

Methods: Observational study in a university hospital. In 58 patients with severe brain injury receiving mechanical ventilation, CPIS, PCT, CRP and SAA were evaluated at ICU entry and at days 3 to 4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or BAL cultures).

Results: We found the following: (1) PCT at entry was increased in patients who later had early VAP develop (25 patients) compared to no VAP (median, 1.4 ng/mL; 25–75 percentiles, 0.14–0.78; vs median, 0.2 ng/mL; 25–75 percentiles, 0.76–2.4, p < 0.001; sensitivity, 76%; and specificity, 75%); (2) CPIS increased at the day of VAP diagnosis, compared to entry (median, 6.6 ± 1.1 vs 1.5 ± 1.1, p < 0.001; sensitivity, 97%; specificity, 100%), while other serum inflammatory markers did not change; and (3) deterioration in oxygenation and changes in tracheal secretions were the main determinants of CPIS changes.

Conclusions: PCT may be a useful marker to predict which patients subsequently have early VAP. The CPIS could help as an early way to detect the patients with early VAP and who need further diagnostic testing.

Key Words: brain injury • clinical infection pulmonary score • C-reactive protein • procalcitonin • serum amyloid A • ventilator-associated pneumonia






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2008 by the American College of Chest Physicians.