Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care

Basem Al-Omari,Amanda Winter,Timothy S Walsh,Sara Graziadio,William S Jones,Peter Mcmeekin,Ahsan R Akram,Jana Suklan,A Joy Allen,Milo Cullinan,Joanne Gray,B Clare Lendrem,Thomas H Craven,Kevin Dhaliwal

doi:10.1186/s12890-021-01560-0

Abstract

BackgroundVentilator-associated pneumonia (VAP) is an important diagnosis in critical care. VAP research is complicated by the lack of agreed diagnostic criteria and reference standard test criteria. Our aim was to review which reference standard tests are used to evaluate novel index tests for suspected VAP.MethodsWe conducted a comprehensive search using electronic databases and hand reference checks. The Cochrane Library, MEDLINE, CINHAL, EMBASE, and web of science were searched from 2008 until November 2018. All terms related to VAP diagnostics in the intensive treatment unit were used to conduct the search. We adopted a checklist from the critical appraisal skills programme checklist for diagnostic studies to assess the quality of the included studies.ResultsWe identified 2441 records, of which 178 were selected for full-text review. Following methodological examination and quality assessment, 44 studies were included in narrative data synthesis. Thirty-two (72.7%) studies utilised a sole microbiological reference standard; the remaining 12 studies utilised a composite reference standard, nine of which included a mandatory microbiological criterion. Histopathological criteria were optional in four studies but mandatory in none.ConclusionsNearly all reference standards for VAP used in diagnostic test research required some microbiological confirmation of infection, with BAL culture being the most common reference standard used.

Highlights

Ventilator-associated pneumonia (VAP) is an important diagnosis in critical care
bronchoalveolar lavage (BAL) culture is the most common reference standard used for VAP diagnostic in ICU and almost all reference standards required some microbiological confirmation of infection
Records that were not published in English were translated to English using Google translator. 2263 articles were excluded on the basis of title and abstract and a further 123 on the basis of full-text screening were excluded as not clinically relevant to the inclusion criteria or meeting at least one of the exclusion criteria, leaving 55 articles for quality assessment

Summary

Introduction

Ventilator-associated pneumonia (VAP) is an important diagnosis in critical care. VAP research is compli‐ cated by the lack of agreed diagnostic criteria and reference standard test criteria. VAP is a preventable nosocomial complication which potentially contributes to avoidable mortality and morbidity [3, 4] It is considered a clinically and epidemiologically important measure of the quality of care [5, 6]. The contribution of an episode of VAP to mortality is difficult to definitively ascertain because of the high number and severity of confounders amongst the at-risk population [4, 11,12,13]. This attributable mortality has been reported from high to neutral or near-neutral [11,12,13]

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