DIAGNOSTIC TESTS FOR PNEUMONIA IN VENTILATED PATIENTS: PROSPECTIVE EVALUATION OF DIAGNOSTIC ACCURACY USING HISTOLOGY AS A DIAGNOSTIC GOLD STANDARD
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Keywords
pneumonia, ventilator-associated pneumonia, mechanical ventilation, diagnosis, diagnostic accuracy, histology
Abstract
Background: A major worldwide health concern is pneumonia in patients on mechanical ventilation, where ventilator-associated pneumonia (VAP) is linked to higher rates of morbidity and death.
Objective: This study's goal was to assess the diagnostic accuracy of histology, the gold standard for diagnosis, in ventilated pneumonia patients.
Methodology: This one-year prospective research included 121 mechanically ventilated (MV) patients who were suspected of having pneumonia at the Hayatabad Medical Complex, Peshawar in Pakistan. Clinical suspicion and post-bronchoscopic lung tissue accessibility was among the criteria. Histological analyses, bacterial cultures, and bronchoscopic procedures were among the clinical and laboratory evaluations carried out. Statistical analysis was conducted using SPSS.
Results: VAP patients had more severe illness at presentation, with a 2.6-point increase in the Simplified Acute Physiologic Score (43.8 vs. 41.2, p=0.02), reduced lung function (Pao/F102 ratio 198 vs. 210, p=0.04), and a higher radiologic score (7.5 vs. 6.3, p=0.01). The non-VAP group's histological testing showed a variety of lung diseases, but the VAP patients showed a greater incidence of lung abscesses (8.3%) and pneumonia (25.0%). Contrary to a five-fold increase in bacterial load in VAP patients, where Klebsiella pneumoniae (46.7%) and Staphylococcus aureus (40.0%) predominated, bacterial cultures in the non-VAP group indicated colonization. Protected Specimen Brush culture showed great specificity (88.5%) for excluding out non-VAP patients, whereas Bronchoalveolar Lavage culture indicated good sensitivity (53.3%) for detecting genuine VAP cases.
Conclusion: This prospective research on ventilated patients' pneumonia emphasizes the difficulties in diagnosing the condition, highlighting the crucial role of histology and the need of thorough diagnostic approaches in critical care.
References
2. Ferrer M, Travierso C, Cilloniz C, Gabarrus A, Ranzani OT, Polverino E, Liapikou A, Blasi F, Torres A. Severe community-acquired pneumonia: characteristics and prognostic factors in ventilated and non-ventilated patients. PloS one. 2018 Jan 25;13(1):e0191721.
3. Kalanuria AA, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Critical care. 2014 Apr;18:1-8.
4. Chastre J, Fagon JY. Ventilator-associated pneumonia. American journal of respiratory and critical care medicine. 2002 Apr 1;165(7):867-903.
5. Cook D. Ventilator associated pneumonia: perspectives on the burden of illness. Intensive Care Medicine. 2000 Feb;26:S031-7.
6. Kollef MH, Burnham CA. Ventilator-associated pneumonia: the role of emerging diagnostic technologies. InSeminars in respiratory and critical care medicine 2017 Jun (Vol. 38, No. 03, pp. 253-263). Thieme Medical Publishers.
7. Vandana Kalwaje E, Rello J. Management of ventilator-associated pneumonia: Need for a personalized approach. Expert review of anti-infective therapy. 2018 Aug 3;16(8):641-53.
8. Rehman A, Xing H, Hussain M, Hussain A, Gulzar N. Emerging technologies for COVID (ET-CoV) detection and diagnosis: Recent advancements, applications, challenges, and future perspectives. Biomedical Signal Processing and Control. 2023 May 1;83:104642.
9. Kollef MH, Burnham CA. Ventilator-associated pneumonia: the role of emerging diagnostic technologies. InSeminars in respiratory and critical care medicine 2017 Jun (Vol. 38, No. 03, pp. 253-263). Thieme Medical Publishers.
10. Strålin K. Usefulness of aetiological tests for guiding antibiotic therapy in community-acquired pneumonia. International journal of antimicrobial agents. 2008 Jan 1;31(1):3-11.
11. Han X, Wu W, Zhao H, Wang S. Developing and validating a prediction model for in-hospital mortality in patients with ventilator-associated pneumonia in the ICU. Annals of palliative medicine. 2022 May 1;11(5):1799-810.
12. Gursel G, Demirtas S. Value of APACHE II, SOFA and CPIS scores in predicting prognosis in patients with ventilator-associated pneumonia. Respiration. 2006 Jun 1;73(4):503-8.
13. Marquette CH, Copin MC, Wallet F, Neviere R, Saulnier F, Mathieu D, Durocher A, Ramon P, Tonnel AB. Diagnostic tests for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard. American journal of respiratory and critical care medicine. 1995 Jun;151(6):1878-88.
14. Koh JW, Wong JJ, Sultana R, Wong PP, Mok YH, Lee JH. Risk factors for mortality in children with pneumonia admitted to the pediatric intensive care unit. Pediatric pulmonology. 2017 Aug;52(8):1076-84.
15. Li M, Wang J, Yao Z, Liao H, Su S, Yang X, Xie M, Zheng Y. Metagenomic-based pathogen surveillance for children with severe pneumonia in pediatric intensive care unit. Frontiers in Public Health. 2023 Jun 15;11:1177069.
16. Malik DJ, Sokolov IJ, Vinner GK, Mancuso F, Cinquerrui S, Vladisavljevic GT, Clokie MR, Garton NJ, Stapley AG, Kirpichnikova A. Formulation, stabilisation and encapsulation of bacteriophage for phage therapy. Advances in colloid and interface science. 2017 Nov 1;249:100-33.
17. Vidal-Cortés P, Lameiro-Flores P, Aller-Fernández A, Mourelo-Fariña M, Fernández-Ugidos P, Gómez-López R, Alves-Pérez M, Rodríguez-García E. Mortality predictors in septic HIV patients in the ICU. Critical Care. 2013 Jan 1;17(Suppl 2):P468.
18. Mondi MM, Chang MC, Bowton DL, Kilgo PD, Meredith JW, Miller PR. Prospective comparison of bronchoalveolar lavage and quantitative deep tracheal aspirate in the diagnosis of ventilator associated pneumonia. Journal of Trauma and Acute Care Surgery. 2005 Oct 1;59(4):891-6.
19. Lambotte O, Misset B, Benali A, Carlet J. The significance of distal bronchial samples with commensals in ventilator-associated pneumonia: colonizer or pathogen?. Chest. 2002 Oct 1;122(4):1389-99.
20. Klompas M. Does this patient have ventilator-associated pneumonia?. Jama. 2007 Apr 11;297(14):1583-93.
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Dr. Rakhshinda Iram
Lecturer Anatomy, Khyber Medical College, Peshawar - Pakistan
Dr. Farrukh Siddique
MPhil Scholar, Khyber Medical University, Peshawar - Pakistan
Dr. Rizwana Iqbal
Lecturer Anatomy, Ayub Medical College, Abbottabad - Pakistan
Dr. Ibrahim Khan
Lecturer, Anatomy Department, Gandhara Medical University, Peshawar - Pakistan
Dr. Shehla Khatoon
Assistant Professor Anatomy, Khyber Medical College, Peshawar - Pakistan
Dr. Hira Shaheen
Demonstrator, Anatomy Department, Khyber Medical College, Peshawar - Pakistan