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Title:
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Ventilator-Associated Pneumonia and PaO2/FIO2 Diagnostic Accuracy: Changing the Paradigm?
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Author:
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Ferrer Monreal, Miquel; Sequeira, Telma; Cillóniz, Catia; Dominedò, Cristina; Li Bassi, Gianluigi; Martín Loeches, Ignacio; Torres Martí, Antoni
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Notes:
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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. |
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Subject(s):
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-Unitats de cures intensives
-Infeccions nosocomials
-Pneumònia
-Intensive care units
-Nosocomial infections
-Pneumonia |
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Rights:
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cc by (c) Ferrer Monreal et al., 2019
http://creativecommons.org/licenses/by/3.0/es/
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Document type:
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Article
Article - Published version |
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Published by:
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MDPI
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