- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT04911244
Diagnostic Modalities for VAP Detection
Assessment of Different Diagnostic Modalities for Detection of Ventilator Associated Pneumonia
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
Ventilator associated pneumonia (VAP) is a common cause of nosocomial infection, that can complicate mechanical ventilation and is related to significant utilization of health-care resources.
The diagnosis of VAP is subjected to considerable interobserver variability. The Centers for Disease Control and Prevention (CDC) definition of VAP uses a combination of clinical, radiographic, and micro-biological criteria for diagnosis, but in the absence of a definite diagnostic test, the accurate diagnosis and treatment of VAP is limited.
The clinical pulmonary infection score (CPIS) was developed to objectively diagnose VAP and assign points on the basis of clinical and radiographic data, but its role in diagnosing pneumonia remains controversial .
Lung ultrasound (LUS) is a simple, non irradiating, noninvasive, cost-effective, bedside technique. It has been successfully applied for monitoring aeration and monitoring antibiotic efficacy in ventilator-associated pneumonia (VAP). However, no scientific evidence is yet available on whether LUS reliably improves the diagnosis of VAP.
Quantitative bacterial cultures of the specimen obtained from the lower airways using bronchoscope were proposed for VAP diagnosis with a cut off value of 104 colony-forming unit/ml. However, microbiological cultures cannot guide the early clinical management of patients with a suspected VAP, as they need at least 24 hours for preliminary results. So, starting antibiotics remains a challenge. Moreover, bronchoscopy is not always easy to perform in hypoxemic patients and not promptly available in all ICUs. Therefore, it can be replaced by tracheal aspirate microbiological samples.
Studietype
Registrering (Faktiske)
Fase
- Ikke aktuelt
Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- All adult patients mechanically ventilated for at least 48 hours in Respiratory ICU were included in the study.
who had:
- Clinically suspected VAP according to simplified Clinical Pulmonary Infectious Score exceeding 6.
Or new or extension of a radiological image with at least two of the following clinical criteria:
- Body temperature ≥ 38.5 ° C or <36 ° C.
- Leukocytes> 10 * 103 / ml or <4 * 103/ ml or > 10% immature cells (in the absence of other known causes).
- Purulent tracheal secretions.
- Hypoxemia with PaO2 <60 mmHg or a PaO2 / FiO2 <300.
Exclusion Criteria:
- Patients with diagnosis of community acquired pneumonia or hospital acquired pneumonia before starting of mechanical ventilation.
- Patients who are contraindicated for bronchoscopy
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Diagnostisk
- Tildeling: Ikke-randomisert
- Intervensjonsmodell: Enkeltgruppeoppdrag
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Eksperimentell: VAP group
patients confirmed diagnosis of VAP with bronchoalveolar lavage
|
endobronchial sampling through bronchoscopy
Andre navn:
|
Eksperimentell: Non VAP group
patients confirmed not VAP with bronchoalveolar lavage
|
endobronchial sampling through bronchoscopy
Andre navn:
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
To detected diagnostic accuracy of chest ultrasound in VAP.
Tidsramme: 3 years
|
To identify sensitivity and specificity of chest ultrasound in VAP diagnosis
|
3 years
|
To detected diagnostic accuracy of protected endotracheal aspirate in VAP.
Tidsramme: 3 years
|
To identify sensitivity and specificity of protected endotracheal aspirate in VAP diagnosis
|
3 years
|
To detected diagnostic accuracy of usual endotracheal aspirate in VAP.
Tidsramme: 3 years
|
To identify sensitivity and specificity of usual endotracheal aspirate in VAP diagnosis
|
3 years
|
To detected diagnostic accuracy of chest X-ray in VAP.
Tidsramme: 3 years
|
To identify sensitivity and specificity of chest X-ray in VAP diagnosis
|
3 years
|
Samarbeidspartnere og etterforskere
Sponsor
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, Girard M, Lu Q, Rouby JJ. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010 Jan;38(1):84-92. doi: 10.1097/CCM.0b013e3181b08cdb.
- Nair GB, Niederman MS. Ventilator-associated pneumonia: present understanding and ongoing debates. Intensive Care Med. 2015 Jan;41(1):34-48. doi: 10.1007/s00134-014-3564-5. Epub 2014 Nov 27.
- Mongodi S, Via G, Girard M, Rouquette I, Misset B, Braschi A, Mojoli F, Bouhemad B. Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia. Chest. 2016 Apr;149(4):969-80. doi: 10.1016/j.chest.2015.12.012. Epub 2015 Dec 22.
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Patologiske prosesser
- Infeksjoner
- Luftveisinfeksjoner
- Sykdommer i luftveiene
- Lungesykdommer
- Sykdomsattributter
- Kryssinfeksjon
- Iatrogen sykdom
- Helse-assosiert lungebetennelse
- Lungebetennelse
- Lungebetennelse, Ventilator-Associated
- Molekylære mekanismer for farmakologisk virkning
- Chelaterende midler
- Sekvesteringsagenter
- Dimercaprol
Andre studie-ID-numre
- VAP diagnosis
Legemiddel- og utstyrsinformasjon, studiedokumenter
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Kliniske studier på Ventilator Associated Pneumonia
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Centre Hospitalier Universitaire de BesanconGlaxoSmithKline; French Society for Intensive Care; SmithKline BeechamFullførtPneumonia Ventilator Associated
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University of MichiganNational Institutes of Health (NIH); National Center for Advancing Translational...FullførtVAP - Ventilator Associated PneumoniaForente stater
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Erasmus Medical CenterChiesi Farmaceutici S.p.A.FullførtTilsetning av tobramycin inhalasjon ved behandling av respiratorassosiert lungebetennelse (VAPORISE)Ventilator Associated Pneumonia (VAP)Spania, Nederland
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Andrzej Frycz Modrzewski Krakow UniversityFullførtVAP - Ventilator Associated PneumoniaPolen
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Assiut UniversityHar ikke rekruttert ennåVAP - Ventilator Associated Pneumonia
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Ain Shams UniversityFullførtVAP - Ventilator Associated PneumoniaEgypt
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Hospital Alemão Oswaldo CruzMinistry of Health, BrazilRekrutteringHelse-assosiert lungebetennelse | Ventilator-assosiert lungebetennelse | Healthcare Associated InfectionBrasil
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University Medical Centre LjubljanaFullførtvedlikehold av normoglykemi | Forekomsten av Ventilator Associated Pneumonia (VAP) | Behandlingsperiode på intensivavdelingenSlovenia
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Groupe Hospitalier Paris Saint JosephRekrutteringVentilator-assosiert lungebetennelseFrankrike