Diagnosing ventilator-associated pneumonia (VAP) in UK NHS ICUs: the perceived value and role of a novel optical technology

W S Jones,A J Allen,A Bruce,K Dhaliwal,A Winter,S Graziadio,T Walsh,A J Simpson,T Craven,J Suklan,K Green,J Mair

doi:10.1186/s41512-022-00117-x

Abstract

BackgroundDiagnosing ventilator-associated pneumonia (VAP) in an intensive care unit (ICU) is a complex process. Our aim was to collect, evaluate and represent the information relating to current clinical practice for the diagnosis of VAP in UK NHS ICUs, and to explore the potential value and role of a novel diagnostic for VAP, which uses optical molecular alveoscopy to visualise the alveolar space.MethodsQualitative study performing semi-structured interviews with clinical experts. Interviews were recorded, transcribed, and thematically analysed. A flow diagram of the VAP patient pathway was elicited and validated with the expert interviewees. Fourteen clinicians were interviewed from a range of UK NHS hospitals: 12 ICU consultants, 1 professor of respiratory medicine and 1 professor of critical care.ResultsFive themes were identified, relating to [1] current practice for the diagnosis of VAP, [2] current clinical need in VAP diagnostics, [3] the potential value and role of the technology, [4] the barriers to adoption and [5] the evidence requirements for the technology, to help facilitate a successful adoption. These themes indicated that diagnosis of VAP is extremely difficult, as is the decision to stop antibiotic treatment. The analysis revealed that there is a clinical need for a diagnostic that provides an accurate and timely diagnosis of the causative pathogen, without the long delays associated with return of culture results, and which is not dangerous to the patient. It was determined that the technology would satisfy important aspects of this clinical need for diagnosing VAP (and pneumonia, more generally), but would require further evidence on safety and efficacy in the patient population to facilitate adoption.ConclusionsCare pathway analysis performed in this study was deemed accurate and representative of current practice for diagnosing VAP in a UK ICU as determined by relevant clinical experts, and explored the value and role of a novel diagnostic, which uses optical technology, and could streamline the diagnostic pathway for VAP and other pneumonias.

Highlights

Pneumonia is a bacterial, viral or fungal infection of the lungs, which causes the alveoli of the lungs to fill up with microorganisms, fluid and inflammatory cells, preventing the lungs from functioning effectively [1]
Care pathway analysis performed in this study was deemed accurate and representative of current practice for diagnosing ventilator-associated pneumonia (VAP) in a UK intensive care unit (ICU) as determined by relevant clinical experts, and explored the value and role of a novel diagnostic, which uses optical technology, and could streamline the diagnostic pathway for VAP and other pneumonias
The classification scheme for pneumonia in UK NHS hospitals is based on the setting in which the infection was mostly likely acquired: community-acquired pneumonia (CAP), when a patient is in the hospital 48h before the pneumonia develops, but is not associated with mechanical ventilation; and ventilator-associated pneumonia (VAP), when a patient is mechanically ventilated and intubated for >48h before the pneumonia develops [2,3,4]

Summary

Introduction

Viral or fungal infection of the lungs, which causes the alveoli of the lungs to fill up with microorganisms, fluid and inflammatory cells, preventing the lungs from functioning effectively [1]. VAP in the ICU is the leading cause of death relating to infection [3, 5,6,7] and is associated with increased duration of mechanical ventilation, length of stay (in the ICU and hospital), morbidity and healthcare costs [8,9,10,11]. Diagnosing ventilator-associated pneumonia (VAP) in an intensive care unit (ICU) is a complex process. Our aim was to collect, evaluate and represent the information relating to current clinical practice for the diagnosis of VAP in UK NHS ICUs, and to explore the potential value and role of a novel diagnostic for VAP, which uses optical molecular alveoscopy to visualise the alveolar space

Objectives

Methods

Results

Discussion

Conclusion