Diagnostic Modalities for VAP Detection
Assessment of Different Diagnostic Modalities for Detection of Ventilator Associated Pneumonia
研究概览
详细说明
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.
研究类型
注册 (实际的)
阶段
- 不适用
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
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
学习计划
研究是如何设计的?
设计细节
- 主要用途:诊断
- 分配:非随机化
- 介入模型:单组作业
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:VAP group
patients confirmed diagnosis of VAP with bronchoalveolar lavage
|
endobronchial sampling through bronchoscopy
其他名称:
|
实验性的:Non VAP group
patients confirmed not VAP with bronchoalveolar lavage
|
endobronchial sampling through bronchoscopy
其他名称:
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
To detected diagnostic accuracy of chest ultrasound in VAP.
大体时间: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.
大体时间: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.
大体时间: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.
大体时间:3 years
|
To identify sensitivity and specificity of chest X-ray in VAP diagnosis
|
3 years
|
合作者和调查者
出版物和有用的链接
一般刊物
- 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.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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