Clinical Pulmonary Infection Score Score Research Articles

The predictive value of PCT, SP-D and 8-iso-PGF2 α for the development of severe pneumonia in children

Background: To investigate the predictive value of predictive value of procalcitonin (PCT), 8-iso-prostaglandin F2α (8-iso-PG-F2α) and pulmonary surfactant-associated protein D (SP-D) for the development of severe pneumonia in children. Methodology: Children with severe pneumonia were selected as the pneumonia group, and children with non-pulmonary respiratory diseases were selected as the control group. PCT, 8-iso-PGF2α, and SP-D were compared between the pneumonia group and the control group at admission; PCT, 8-iso-PGF2α, SP-D, and Acute Physiology and Chronic Health Evaluation (APACHE-II), Pediatric Critical Illness Score (PCIS) and Clinical Pulmonary Infection Score (CPIS) scores were compared between children with severe pneumonia with different pathogen infection types and different prognostic outcomes; and the correlation between APACHE-II, CPIS, and PCIS scores and PCT, 8-iso-PGF2α, and SP-D levels was analysed in children with severe pneumonia. Results: PCT, 8-iso-PGF2α and SP-D in pneumonia group were higher than those in control group. PCT, 8-iso-PGF2α, SP-D, APACHE-II, CPIS, and PCIS were lower in good prognosis children than in poor prognosis children. APACHE-II, CPIS, and PCIS scores were positively correlated with PCT, 8-iso-PGF2α, and SP-D levels in children with severe pneumonia (P < 0.05). Conclusion: PCT, SP-D and 8-iso-PGF2α levels relate to pathogen type, illness severity and prognosis in children with severe pneumonia. They can aiding early evaluation. Keywords: severe pneumonia in children; procalcitonin; 8-isoprostane F2α; pulmonary surfactant-associated protein D; disease assessment.

The Clinical Pulmonary Infection Score Combined with Procalcitonin and Lung Ultrasound (CPIS-PLUS), a Good Tool for Ventilator Associated Pneumonia Early Diagnosis in Pediatrics.

Ventilator-associated pneumonia (VAP) is common in Pediatric Intensive Care Units. Although early detection is crucial, current diagnostic methods are not definitive. This study aimed to identify lung ultrasound (LUS) findings and procalcitonin (PCT) values in pediatric patients with VAP to create a new early diagnosis score combined with the Clinical Pulmonary Infection Score (CPIS), the CPIS-PLUS score. Prospective longitudinal and interventional study. Pediatric patients with suspected VAP were included and classified into VAP or non-VAP groups, based on Centers of Disease Control (CDC) criteria for the final diagnosis. A chest-X-ray (CXR), LUS, and blood test were performed within the first 12 h of admission. CPIS score was calculated. A total of 108 patients with VAP suspicion were included, and VAP was finally diagnosed in 51 (47%) patients. CPIS-PLUS showed high accuracy in VAP diagnosis with a sensitivity (Sn) of 80% (95% CI 65-89%) and specificity (Sp) of 73% (95% CI 54-86%). The area under the curve (AUC) resulted in 0.86 for CPIS-PLUS vs. 0.61 for CPIS. In conclusion, this pilot study showed that CPIS-PLUS could be a potential and reliable tool for VAP early diagnosis in pediatric patients. Internal and external validations are needed to confirm the potential value of this score to facilitate VAP diagnosis in pediatric patients.

Efficacy of Sacubitril Valsartan sodium tablets in patients with heart failure combined with pulmonary infection and long-term recurrence rate.

To observe the therapeutic effect of Sacubitril Valsartan sodium tablets (SVST) on heart failure (HF) complicated by pulmonary infection (PI), and to provide a reference for future medication. A total of 89 patients with HF complicated by PI who were treated at Dongying People's Hospital from January 2019 to May 2020 were selected as study subjects in this retrospective study. The control group consisted of 41 patients who received conventional treatment, while the study group included 48 patients who received SVST in addition to conventional treatment. The time to disappearance/improvement of chest tightness, shortness of breath, cough, and moist rales in both groups were recorded. The levels of brain natriuretic peptide (BNP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and procalcitonin (PCT) were measured before and after treatment. Changes in cardiac function were observed, and the Clinical Pulmonary Infection Score (CPIS) and Sequential Organ Failure Assessment (SOFA) were used to assess PI. The clinical efficacy and adverse reactions were evaluated after treatment. Follow-up lasted 2 years, during which the readmission rate due to HF and mortality rate were calculated. Patients in the study group experienced a shorter time to disappearance/improvement of chest tightness, shortness of breath, cough, and moist rales compared to the control group (all P<0.05). The study group also showed reduced levels of BNP, IL-6, TNF-α, and PCT, as well as lower CPIS and SOFA scores after treatment (all P<0.05), with significantly improved cardiac function (P<0.05). Additionally, the total effective rate was higher in the study group than in the control group (P<0.05), and there was no significant difference in adverse reactions between the two groups (P>0.05). Follow-up revealed no difference in mortality between the two groups (P>0.05), but the study group had a lower readmission rate (P<0.05). SVST is effective in treating HF complicated by PI, ensures a good prognosis for patients, and is recommended for clinical use.

Clinical efficacy of Buzhong Yiqi decoction in the treatment of hospital-acquired pneumonia with multi-drug resistant bacteria: a prospective, randomized, multicenter controlled trial.

To evaluate the efficacy and safety of Buzhong Yiqi decoction (, BZYQ) in the treatment of hospital-acquired pneumonia (HAP) with multi-drug-resistant bacteria (MDRB). This 28-day study was conducted at 5 clinical centers in Shanghai. The eligible patients were randomly assigned (1:1) into the intervention group (BZYQ plus conventional Western Medicine therapy) and control group (conventional Western Medicine therapy). The primary outcomes were the clinical response, clinical pulmonary infection score (CPIS), and microbiologic response. The secondary outcomes were the 28-day all-cause mortality (ACM), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, ventilator weaning rate, length of mechanical ventilation (MV), length of hospital stay, and changes of infection indicators. Altogether 83 subjects in the intervention group and 85 subjects in the control group were analyzed. The clinical success rate (48.2%) and the pathogen eradication rate (59.0%) of the intervention group were all better than those of the control group (32.9% and 38.9%, respectively) with statistically significant differences (<0.05). The CPIS score of the intervention group (8.9 ± 1.7) was lower than that of the control group (9.6 ± 2.5) (<0.05). The length of MV in the intervention group [(13.7 ± 6.4) d] was significantly shorter than that of the control group [ (17.2 ± 7.2) d] (<0.05). The 28-day ACM of the intervention group (13.33%) was lower than that of the control group (21.2%) with no statistically significant difference (>0.05). The differences between two groups in ventilator weaning rate, length of hospital stay, and APACHE Ⅱ score were not statistically significant (> 0.05). The intervention group displayed decreases in white blood cell count, C-reactive protein, neutrophil percentage, and procalcitonin at day 28 compared with baseline (<0.05). No serious adverse events occurred in either group during the 28-day follow-up. BZYQ may be an effective therapeutic option for the management of HAP with MDRB.

The Immunoadsorption Effect of Veno-arterial Extracorporeal Membrane Oxygenation in Refractory Septic Shock, Ventilator-associated Pneumonia, and Acute Respiratory Distress Syndrome Following Severe Pulmonary Contusions

Background: The utilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for immunoadsorption has proven efficacious in reducing mortality rates among neonatal and pediatric patients afflicted with severe sepsis and septic shock. However, the effectiveness of this treatment in adult patients with septic shock remains controversial. Objective: This study was designed to assess the potential of VA-ECMO as an immunoadsorption therapy in patients with severe sepsis and septic shock. The primary objective of this study is to evaluate the efficacy of VA-ECMO in improving clinical outcomes, including acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP), weaning from mechanical ventilation, the length of intensive care unit (ICU) stay, and mortality rates in patients with concurrent severe pulmonary contusions, septic shock, and respiratory failure resulting from ARDS and VAP. Methods: This study enrolled a cohort of 100 adult patients with severe pulmonary contusions resulting in persistent respiratory failure despite ten days of mechanical ventilation. These patients subsequently developed severe sepsis, VAP with ARDS presentation, and high Murray score (&gt;3 points), Sequential Organ Failure Assessment (SOFA) score (&gt; 12 points), and Clinical Pulmonary Infection Score (CPIS) (&gt; 6 points). The patients were then divided into two groups: group A (n = 50) received conventional management, while group B (n = 50) underwent VA-ECMO. Moreover, the outcomes, including improvement in ARDS and VAP, successful weaning from mechanical ventilation, length of ICU stay, improvement of one or all parameters of Murray, SOFA, and CPIS scores, morbidity rate, and mortality rate were compared between the two groups and recorded after 14 days of treatment. Results: This study revealed that patients in group B showed significant improvement in Murray, SOFA, and CPIS scores. Furthermore, a large percentage of patients in group B were successfully weaned from both inotropic support and mechanical ventilation and were discharged from ICU. However, no significant difference in the mortality rate was observed between the two groups. Conclusion: VA-ECMO notably impedes the progression of sepsis, shortens ICU stay, and expedites the weaning from inotropic support and mechanical ventilation. However, it has no impact on the mortality rate of adult patients with septic shock.

Diagnostic Accuracy of Lung Ultrasound versus Chest Radiograph for Early Diagnosis of Ventilator-associated Pneumonia: An Observational Study

Introduction: Ventilator-associated Pneumonia (VAP) is one of the leading causes of morbidity and mortality in intensive Intensive Care Unit (ICU) and is diagnosed by clinical symptoms, Chest X-ray (CXR), Computerised Tomography (CT) and microbiology test in routine practice. Aim: To compare the diagnostic accuracy of Lung Ultrasound (LUS) with gold standard CXR, with or without modified Clinical Pulmonary Infection Score (CPIS) score, for the diagnosis of VAP in ICU. Materials and Methods: This prospective observational study was carried out on 40 mechanically ventilated patients in Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India over the duration of one year from November 2018 - October 2019. The study was continued till VAP was diagnosed by all three modalities (CXR, LUS and microbiology) or to the maximum of 10 days postintubation whichever was less. Data was analysed with appropriate statistical tools “MedCalc”. Results: The mean age of patients was 45.78±15.99 years and there were 28 male and 12 females. The diagnosis of VAP was earliest with LUS (3.1±0.81 days) and (4.22±1.23 days) with CXR when studied alone (p&lt;0.0001). However, when LUS was incorporated in CPIS score instead of CXR the diagnostic accuracy were statistically similar (p&gt;0.05). During the early days (3 &amp;4 day) the diagnostic accuracy (AUC), sensitivity and specificity of LUS was better and was (0.70-0.74, 57-90%) than (0.5; 16.7-83%) with CXR. Fifth day onwards AUC was better with CXR (0.79-0.81) as compared to (0.54-0.70) with LUS. Total leucocyte count (TLC), fever, P/F ratio and sputum quantity were observed individually between the VAP and non VAP group patients and were found to be similar (p&gt;0.05). Conclusion: According to the present observational study, LUS can accurately diagnose VAP when other objective tools like CPIS, CXR and microbiology are inconclusive.

Comparison of Patients with Ventilator-Associated Pneumonia Developed in Two Different Intensive Care Units of a Tertiary Hospital

Aim: Our purpose is to compare the characteristics and 30-day mortality of ventilator-associated&#x0D; pneumonia (VAP) patients that developed in two different intensive care units (ICUs) in a tertiary hospital.&#x0D; Material and Methods: Patients who were over the age of 18 who developed VAP in two different&#x0D; ICUs of our hospital over two years were included in the study. Acute Physiology and Chronic Health&#x0D; Assessment II (APACHE II), Sepsis-Related Organ Failure Assessment (SOFA), Glasgow Coma Score&#x0D; (GCS), Clinical Pulmonary Infection Score (CPIS), infection markers, and 30-day mortality of the&#x0D; patients were evaluated. Physical conditions of Group 1 and Group 2, hand hygiene rates in ICU, nurse&#x0D; education level, and hospitalization rate in intensive care units were compared.&#x0D; Results: A total of 104 patients, 48 being in Group 1 and 56 being in Group 2, were analyzed. There&#x0D; was no significant difference between the two groups with regards of GKS, SOFA and CPIS scores.&#x0D; Acinetobacter baumanni was the most common agent in both groups. The hospitalization rate was&#x0D; found to be significantly higher in Group 2. 30-day mortality was 45.8% in Group 1 and 48.2% in Group&#x0D; 2. It was found that a one unit increase in the SOFA hospitalization period reduced the risk of 30-day&#x0D; mortality. It was determined that a one unit increase in the age ratio in Group 2 increased the risk of&#x0D; 30-day mortality 1.085 times, and the increase in the mean SOFA score in all patients and Group 1&#x0D; decreased the length of the hospitalization period.&#x0D; Conclusion: We found a 30-day mortality rate of 47.1% in patients diagnosed with VAP. An increase in&#x0D; SOFA score increases the risk of 30-day mortality, while a prolonged hospitalization period decreases&#x0D; the risk of mortality.

Clinical effect of antibiotic combined with fiber bronchoscope perfusion in treatment of pneumonia after severe cerebral hemorrhage.

To explore the curative effect of antibiotic combined with mucosolvan perfusion under fiber bronchoscope in treatment of pneumonia after severe cerebral hemorrhage. The clinical data of 120 patients with pneumonia after severe cerebral hemorrhage admitted to our hospital from January 2017 to December 2019 were collected. All patients were divided into the lavage group and perfusion group by random number method, with 60 patients in each group. Patients in the lavage group received antibiotics combined with mucosolvan lavage therapy under fiber bronchoscope, while patients in the perfusion group received antibiotics combined with mucosolvan perfusion therapy under fiber bronchoscope. Clinical pulmonary infection score (CPIS), arterial blood gas index, clinical symptom improvement, and hospitalization costs were compared between the two groups before and after treatment. CPIS scores were improved after treatment in both groups (P < .05), and CPIS scores of patients in the perfusion group were lower than those in the lavage group at 3, 5, and 7 days after treatment (P < .05). The blood oxygen saturation and partial arterial oxygen pressure of the perfusion group were all higher than those of the lavage group (P < .05), while the partial carbon dioxide pressure was lower than that of the lavage group (P < .05). In the perfusion group, the duration of cough, adequacy of fever, disappearance of rhonchus in the lungs, and the length of hospital stay were less than those in the lavage group (P < .05). The hospitalization costs of perfusion group were lower than that of lavage group (P < .05). The combination of antibiotics and mucosolvan infusion therapy under fiber bronchoscope can effectively improve the clinical efficacy, reduce the hospitalization cost, and improve the prognosis of patients with pneumonia after severe cerebral hemorrhage.

Protective Effect of Targeted Fluid Therapy on Patients with One-Lung Ventilation.

Objective To evaluate the protective effect of target-directed fluid therapy on the lungs and postoperative rehabilitation in elderly patients with single-lung ventilation undergoing total endoscopic radical resection of esophageal cancer. Methods Seventy elderly patients who underwent total endoscopic radical resection of esophageal cancer from January 2017 to December 2019 in our hospital were selected and divided into two groups by the random number table method: the goal-directed fluid treatment group (group G, n = 35) and the control group (group C, n = 35). Venous blood was extracted before surgery (T1), at the end of free esophagus (T2) by thoracoscopy, at the end of abdominal surgery (T3), and at the end of surgery (T4). IL-6 and IL-10 levels were detected by ELISA. The clinical pulmonary infection score (CIPS) was used to evaluate the pulmonary inflammation on the second day after surgery and the occurrence of complications. Duration of antibiotic use and length of hospital stay were recorded. Results At T1, there were no significant differences in IL-6 and IL-10 levels between the two groups (P > 0.05). At T2, the IL-6 level in group G increased to 26.65 ± 1.80 pg/ml but was significantly lower than that in group C (32.28 ± 3.22 pg/ml) (P < 0.01). At T3 and T4, IL-6 and IL-10 levels in group G were significantly lower than those in group C (P < 0.01). The CIPS score of group G was lower than that of group C (1.5 ± 1.0 vs 2.7 ± 1.4), and the duration of antibiotic use in group G was shorter than that in group C (211.2 ± 15.4 vs 232.6 ± 18.7 h), with statistical significance (P < 0.01). The incidence of complications in group G was lower than that in group C (28.6% vs 40.0%), and the length of hospital stay in group G was shorter than that in group C (10.5 ± 1.7 vs 11.2 ± 1.9 days), but there was no significant difference between the two groups (P > 0.05). Conclusion Target-directed fluid therapy inhibited inflammatory cytokine levels and had better lung protection, but no significant benefit in the complications or the length of hospital stay was observed.

Effect of Capsaicin Atomization-Induced Cough on Sputum Excretion in Tracheotomized Patients After Hemorrhagic Stroke: A Randomized Controlled Trial.

Background Timely and effective removal of respiratory secretions is of great significance for tracheotomized patients. The purpose of this study is to investigate the effectiveness of capsaicin nebulization to stimulate cough to promote early clearance of respiratory secretions in tracheotomized patients after hemorrhagic stroke. Method This study implemented a randomized controlled design. Sixty-three patients who were tracheotomized following a hemorrhagic stroke completed this randomized controlled trial. In the control group, 33 cases were given a routine care after tracheotomy. In the intervention group, 30 cases were given a capsaicin solution nebulization in addition to the routine care. The daily sputum output and the number of sputum suctioning were observed. The differences in sputum viscosity, cough function, and Clinical Pulmonary Infection Score (CPIS) were compared between the two groups before and after the intervention. Vital sign changes during capsaicin nebulization and suctioning were compared between the two groups in a pilot study. Results The daily sputum output of the capsaicin intervention group was significantly higher than that of the control group (p < .05). The number of sputum suctioning of capsaicin group was less than that of the control group after intervention (p < .05). The CPIS score of the capsaicin group was lower than that of the control group (p < .05) after a 1-week intervention. Patients' heart rate, respiratory rate, and oxygen saturation during capsaicin nebulization were not statistically different from those during routine sputum suctioning (p > .05). Conclusions Capsaicin atomization-induced cough can effectively promote sputum excretion of hemorrhagic stroke patients undergoing tracheotomy and has a good safety profile. The Clinical Trial registration number of this study is ChiCTR2000037772 (http://www.chictr.org.cns). Supplemental Material https://doi.org/10.23641/asha.16821352.

The Potential Role of Aerosolized Colistin in the Ventilator-Associated Pneumonia Management Caused by Multidrug-Resistant Gram-Negative Bacteria: A Randomized Clinical Trial

Background: Infections caused by multidrug-resistant (MDR) pathogen have caused a resurgence of interest in colistin. To date, information about the effectiveness of Aerosolized Colistin (AS) is very limited in the treatment of Ventilator-Associated Pneumonia (VAP). The aim of this study is to evaluate the efficacy and safety of AS in conjunction with intravenous (IV) colistin in patients with VAP, caused by MDR Gram-Negative Bacteria (GNB). Methods: This parallel randomized clinical trial was conducted on patients with VAP in the Intensive Care Unit (ICU) ward. 27 patients allocated to the intervention or the control group. Patients in the intervention group received IV Colistin based on glomerular filtration rate along with aerosolized Colistin, 2 million units three times a day. In the control group, only IV Colistin was administered. For all patients, Procalcitonin (PCT), sputum culture, and Clinical Pulmonary Infection Score (CPIS) were evaluated and compared as outcome measures at the specified period of time. Results: Negative sputum culture was achieved in 9 (80%) out of 11 patients in the AS-IV Colistin group after seven days of therapy versus 9 (56.25%) out of 16 in the control group (P= 0.01). PCT and CPIS scores were not significantly different between two groups (P=0.21, P= 0.62). Furthermore, nephrotoxicity and neurotoxicity were not seen. Conclusion: AS Colistin lead to earlier negative sputum culture without increasing risk of nephrotoxicity and neurotoxicity, and could potentially be a beneficial adjunctive approach in the management of MDR-VAP.

A comparative study between effect of combined intravenous and nebulized amikacin versus intravenous amikacin alone in mechanically ventilated patients with ventilator-associated pneumonia (VAP)

BackgroundAerosolized antibiotic administration offers the theoretical advantages of achieving high drug concentrations at the infection site together with lower systemic absorption. This study aims to compare the effect of combining nebulized amikacin with intravenous amikacin to the effect of the usual intravenous route alone in the treatment of patients with ventilator-associated pneumonia and its impact on the duration of mechanical ventilation, laboratory, and clinical picture of the patients.ResultsThis study was carried out on 64 mechanically ventilated patients with Gram-negative VAP. The patients were divided into 2 groups. Group A included 32 patients treated with nebulized amikacin plus IV amikacin, and group B included 32 patients treated with IV amikacin alone. The duration of treatment for both groups was 8 days with a daily assessment of Clinical Pulmonary Infection Score (CPIS) and monitoring of clinical and laboratory parameters. Sputum cultures were obtained thereafter. In our study, the CPIS score and overall ICU mortality were less in the nebulized than in the IV group but the difference failed to be statistically significant. Increase of oxygenation level (Pao2/Fio2 ratio), organism clearance, decrease in serum creatinine level, duration of mechanical ventilation, and length of ICU stay were significantly different in favor of group A than group B.ConclusionNebulized and IV amikacin offered better oxygenation, organism clearance, less nephrotoxicity, and less duration of mechanical ventilation and ICU stay than the IV group. Combined and IV routes were comparable regarding the decrease in CPIS score and ICU mortality with no significant difference between them. However, we prefer to use the combined regimen for the mentioned reasons. Further large-scale studies are required to confirm these findings and to establish a definite conclusion.

Application of the respiratory \u201ccritical care-sub-critical care-rehabilitation integrated management model\u201d in severe stroke associated pneumonia

BackgroundThis study aimed to explore the feasibility of applying the respiratory “critical care-sub-critical care-rehabilitation integrated management model” in severe stroke-associated pneumonia and evaluate its effect.MethodsFrom January to September 2018, 24 patients with severe stroke-associated pneumonia, who were admitted to the Respiratory Intensive Care Unit of the Respiratory and Critical Care Medicine Department of Henan Provincial People’s Hospital, were randomly divided into two groups: integrated management group and control group. According to the admission criteria of the respiratory “critical care-sub-critical care-rehabilitation integrated model” prescribed by the above-mentioned hospital, patients were grouped. The professional respiratory therapy team participated in the whole treatment. The acute physiology and chronic health evaluation II (APACHE II) score, clinical pulmonary infection score (CPIS) and oxygenation index of these two groups were dynamically observed, and the average hospital stay, 28-day mortality and patient satisfaction were investigated.ResultsPatients in the integrated management group and control group were similar before treatment (P > 0.05). After treatment, the main indicators, the APACHE II score, CPIS score and oxygenation index, were significantly different between the integration group and control group (P < 0.05). The secondary indicators, the average hospitalization days and patient/family member satisfaction scores, were also significantly different between the integration group and control group (P < 0.05). However, the 28-day mortality wasn’t significantly different (P > 0.05).ConclusionsFor patients with severe stroke-associated pneumonia, it was feasible to implement the respiratory “critical care-sub-critical care-rehabilitation integrated management model”, which could significantly improve the treatment effect, shorten average hospitalization days and improve patient/family satisfaction.

Comparative Evaluation of the Role of Nonbronchoscopic and Bronchoscopic Techniques of Distal Airway Sampling for the Diagnosis of Ventilator-Associated Pneumonia.

Background:The diagnosis of ventilator-associated pneumonia (VAP) remains a challenge, with clinicians mainly relying on clinical, radiological, and bacteriologic strategies to manage patients with VAP.Aims:To compare the results of non-bronchoscopic and bronchoscopic techniques of distal airway sampling for the diagnosis of VAP.Settings and Design:This was a single-center prospective diagnostic accuracy study done in the 14-bedded intensive care unit of a tertiary care referral hospital.Materials and Methods:Patients aged ≥18 years, on mechanical ventilation for ≥48 h, and with clinical suspicion of VAP (fever, leukocytosis, and increased tracheal secretions) either on admission or during their stay were included. Every patient underwent both procedures for sample collection, first non-bronchoscopic protected bronchoalveolar lavage (NP-BAL) and then bronchoscopic BAL (B-BAL). Clinical Pulmonary Infection Score (CPIS) was calculated for each patient and the collected samples were evaluated in laboratory using standard microbiological techniques.Statistical Analysis Used:The sensitivity, specificity, positive predictive value, and negative predictive value of NP-BAL and B-BAL for the diagnosis of VAP were calculated taking CPIS score of >6 as index test for the diagnosis of VAP.Results:Sixty patients were included in the study. Both NP-BAL and B-BAL had concordance with the CPIS at 69.1%. The concordance between NP-BAL and B-BAL was better at 67.6% with a kappa coefficient of 0.064 (P = −0.593). The yield and sensitivity of NP-BAL were comparable to that of B-BAL.Conclusions:The blind NP-BAL is an equally effective method of airway sampling and could be a better alternative to replace more invasive B-BAL for microbiologic diagnosis of VAP.

Diagnostic efficacy of serum procalcitonin, C-reactive protein concentration and clinical pulmonary infection score in Ventilator-Associated Pneumonia.

The aim of this study was to evaluate the diagnostic efficacy of serum procalcitonin (PCT), c-reactive protein (CRP) concentration and clinical pulmonary infection score(CPIS) in ventilator-associated pneumonia(VAP). Forty-nine patients who were admitted to the intensive care unit (ICU) of Zhejiang Hospital with suspected VAP were recruited in this study. The serum level of PCT and CRP of all patients were measured and CPIS was calculated at the time of VAP suspected diagnosis. Of the included 49 patients, 24 were finally confirmed of VAP by microbiology assay. And the other 25 patients were considered as clinical suspected VAP without microbiology confirmation. The diagnostic sensitivity, specificity and area under the receiver operating characteristic (ROC) curve (AUC) were calculated using the serum PCT, CRP concentration and CPIS. The correlation among serum PCT, CRP concentration and CPIS were also evaluated by Spearson correlation test. A total of 100 bronchoscopic aspiration sputum specimen were examined in bacterial culture. 30 samples were found with suspected pathogenic bacteria. Six samples were found with 2 types of suspected pathogenic bacteria. PCT serum concentration and CPIS score were significantly different (P<0.05) between the patient group [1.4 (0.68 ∼ 2.24), 6.0 (4.25 ∼ 8.00)] and the control group [0.4 (0.17 ∼ 1.39), 3.0 (1.00 ∼ 5.00)] ; However, the serum CRP [102.8(66.75 ∼ 130.90) vs 86.1(66.95 ∼ 110.10)] was not statistically different between the two groups (P>0.05). A significant correlation was found between serum PCT and CRP concentrations (r=0.55, P<0.01), but not between PCT vs CPIS and CRP vs CPIS (p>0.05). The diagnostic sensitivity, specificity and AUC were 72.0%, 75.0%, 0.81 (0.69 ∼ 0.93) for CPIS; 60.0%, 87.5%, 0.76 (0.62 ∼ 0.90) for PCT and 68.0%, 58.3%, 0.59 (0.43 ∼ 0.76) for CRP. PCT serum level and CPIS score are elevated in VAP patients and could therefore represent potential biomarkers for VAP early diagnosis.

New Biomarkers to Diagnose Ventilator Associated Pneumonia: Pentraxin 3 and Surfactant Protein D.

To detect the most effective biomarker to confirm ventilator associated pneumonia (VAP). Fifty patients with VAP suspicious diagnosis and 30 healthy patients were recruited. Suspicion of VAP was established if patients met the modified CPIS score ≥ 6 points. The confirmation of VAP was defined by the quantitative culture of nonbronchoscopic bronchoalveolar lavage (BAL) >105CFU/ml of pathogenic microorganism. Serum samples for determination of C-reactive protein (CRP), procalcitonin (PCT), pentraxin 3 (PTX3), surfactant protein D (SPD) were collected on suspected VAP. Twenty seven of 50 patients were accepted as confirmed VAP group whose nonbronchoscopic BAL cultures were positive and rest of them were accepted as unconfirmed VAP group. PTX3, PCT and SPD levels were significantly higher in confirmed VAP group, (P = 0.021, P = 0.007, P < 0.001 respectively). There were no significant differences in CRP levels between the two groups (P = 0.062). The most sensitive marker for diagnosing VAP was SPD (P < 0.001). Receiver operating characteristic (ROC) curve for modified clinical pulmonary infection score (CPIS) to confirm VAP was evaluated (AUC 0.741 ± 0.07, P < 0.001) and the optimal cutoff value was >7 with a sensitivity of 51.85% and a specificity of 91.3%. SPD levels were significantly higher in Acinetobacter baumannii and Pseudomonas aeruginosa infected patients than culture negative patients (P < 0.001). The index findings suggest that serum SPD is the most sensitive biomarker in diagnosis of VAP and it can be used as an early and organism specific marker for Acinetobacter baumannii and Pseudomonas aeruginosa.

Effects of oral care with glutamine in preventing ventilator-associated pneumonia in neurosurgical intensive care unit patients

PurposeThe study was designed as a randomized, controlled, experimental study aiming to determine the effects of oral care with glutamine in preventing ventilator-associated pneumonia in patients admitted to neurosurgical intensive care unit. MethodsThe universe consisted of patients who are admitted to neurosurgical intensive care unit between January 2014 and August 2015, while the sample consisted of 88 patients who fulfilled the inclusion criteria and were randomly selected. The study group received oral care with 5% glutamine, whereas the control group received oral care with 2% chlorhexidine gluconate solution. Data collecting toolsAll date was acquired using Patient Information Form, Acute Physiological and Chronic Health Evaluation scale (APACHE II), Beck Oral Assessment Scale (BOAS), Mucosal Plaque Score (MPS) and Clinical Pulmonary Infection Score (CPIS). One-way ANOVA test was used for comparing parameters with normal distribution between groups along with descriptive statistical methods. Kruskal-Wallis Test was used for comparing parameters without normal distribution between groups. ResultsIn the control group, mean BOAS score was 9.33±1.8 mean MPS score was 3.68±0.87 and mean CPIS score was 4.07±1.78. In the study group, mean BOAS score was 10.16±2.78, mean MPS score was 3.93±1.04 and mean CPIS score was 3.78±2.25. There was no statistically significant difference in mean scores at 1st day, 3rd day, 5th day and discharge (p>0.05). However, BOAS, MPS, CPIS and APACHE II scores was significantly lower at discharge than 1st day in both groups. ConclusionThere was no significant difference in using 5% glutamine or 2% chlorhexidine gluconate solution for oral care for the prevention of ventilator-associated pneumonia. Similar studies with bigger sample size and longer term should be conducted for better results.

Clinical effectiveness study on artificial airway sequential mechanical ventilation patients withdraw machine pull out

Objective On patients with mechanical ventilation spontaneous breathing trial (SBT) success, out of breath machine smoothly pulled out after endotracheal intubation for active airway moist sequential therapy of clinical new method and new technology. Methods Between January 2013 and May 2014 respiratory endotracheal intubation implementation of mechanical ventilation with intensive medicine successful withdraw machine pulled out of 135 patients with tracheal intubation, they were divided into group A(68 cases) and group B(67 cases) by random digits table method. The patients in group A were treated with buoy type oxygen device, group B with active airway moist heat treatment unit. The breathing rate, PaO2, SpO2, heart rate, Clinical Pulmonary Infection Score(CPIS) were measured after 72 h of pull out endotracheal intubation in two groups. Sputum viscosity was evaluated by Airway Secretions Score before pull out endotracheal intubation and after 24, 48, 72 h of pull out endotracheal intubation in two groups. Results There were no significant differences between two groups in gender, age, clinical diagnosis, mechanical ventilation time, acute physiology and chronic health evaluation system Ⅱ rating etc (P >0.05). The breathing rate, heart rate and CPIS score respectively (20.94±0.89), (80.79±4.67) times/min and (7.13±2.54) points after 72 h of pull out endotracheal intubation in group B, and (24.12±0.97), (86.32±5.12) times/min and (8.79±3.56) points in group A, and there were significant differences(t=5.113, 7.298, 5.597, all P 0.05). After 24, 48 and 72 h of pull out endotracheal intubation, group B of patients with sputum viscosity was suitable in group A (Z=-2.684,-2.870,-2.771, all P < 0.01). Conclusions Mechanical ventilation in patients with ventilator buoy type oxygen device for the pull out after endotracheal intubation success does not favor the sputum drainage, improve patients with dyspnea and hypoxemia is not obvious. By positive airway plus temperature humidity to sequential therapy is helpful to correct hypoxemia, improve the patients' respiratory function, reduce the breathing difficulties, reduce sputum viscosity, promote the airway drainage unblocked, shortening the time of lung infection. Key words: Ventilators, mechanical; Airway management; Ventilator weaning; Intubation; Intratracheal

Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP

Background: The diagnosis of ventilator associated pneumonia (VAP) remains a challenge because the clinical signs and symptoms lack both sensitivity and specificity and the selection of microbiologic diagnostic procedure is still a matter of debate. Objective: To compare the diagnostic value of bronchoscopic BAL and non-bronchoscopic protected BAL in patients with VAP. Materials and methods: Twenty patients, clinically diagnosed with VAP, were involved in this research; they were evaluated by bronchoscopic and non-bronchoscopic BAL for diagnosis of VAP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bronchoscopic and non-bronchoscopic BAL were calculated, taking clinical pulmonary infection score (CPIS) of ⩾6 as reference standard. Results: There was a good microbiologic concordance and strong correlation between bronchoscopic BAL and non bronchoscopic BAL in diagnosis of VAP. There was a high concordance between CPIS score and both procedures’ results. Percentage of concordance between CPIS and bronchoscopic BAL was 97.5% and with non bronchoscopic BAL was 95%. Gram negative organisms were the commonest organisms isolated by both techniques. Conclusion: Non bronchoscopic BAL is an inexpensive, easy, and useful technique for microbiologic diagnosis of VAP. This finding, if verified, might simplify the approach for the diagnosis of VAP.

The role of PCT and CPIS score in the diagnosis of active pulmonary tuberculosis complicated with ventilator associated pneumonia

Objective To explore the value of the variation of clinical pulmonary infection score (CPIS) and serum procalcitonin (PCT) in diagnosis and treatment evaluation in patients suffering from active pulmonary tuberculosis with complication of ventilator-associated pneumonia (VAP). Methods A retrospective analysis was carried out in 58 VAP patients from June 1, 2009 to December 30, 2014 in the respiratory intensive care unit. According to the patient suffering from tuberculosis or not, patients were divided into two groups. The PCT and CPIS score changes were observed in the two groups of patients with intra-tracheal intubation 1, 3 and 7 days after VAP onset. Comparisons of CPIS and PCT scores were carried out between two groups at different intervals after VAP onset. Data were statistically processed by SPSS 19.0. Count data were tested by χ2, and measurement data were expressed by mean±standard deviation (±s). The comparison within the groups was made by t test, whereas the comparison between the groups was by means of repeated measure analysis of variance and Bonferroni test; Pearson linear correlation analysis was used, and P<0.05 was considered statistically significant. Results At the same observation interval in two groups of patients with VAP, there was no significant difference in the serum levels of PCT and CPIS score (P>0.05) ; there were significant differences in PCT and CPIS scores between VAP occurred at the first day, the third day and at time of intra-tracheal intubation in two groups (P 0.05). In addition, at the 7 days the correlation coefficient between PCT and survival patients'mechanical ventilation, days in ICU and total length of hospital stay were 0.92, 0.83, and 0.71, respectively, yet the 7-day CPIS score correlation coefficients were 0.83, 0.74 and 0.70, (both P<0.05) . Conclusions Early monitoring of serum PCT and CIPS score of pulmonary tuberculosis patients can judge the incidence of VAP, and the variations of PCT and CIPS score can predict the severity and prognosis of the disease as well. Key words: Ventilator associated pneumonia; Pulmonary tuberculosis; Procalcitonin; Clinical pulmonary infection score