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Giovanni Zagli, MD, PhD
Author and Funding Information

From the Department of Anesthesia and Intensive Care, Careggi University Hospital.

CORRESPONDENCE TO: Giovanni Zagli, MD, PhD, Department of Anesthesia and Intensive Care, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy; e-mail: giovanni.zagli@unifi.it


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):e107-e108. doi:10.1378/chest.14-2831
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To the Editor:

I thank Drs Feng and Zhang for their interest and comments on our recent CHEST study.1 I agree with them about the challenges in ventilator-associated pneumonia (VAP) diagnosis. In our study population, at the time of diagnosis, VAP was defined in cases of new infiltrates on the chest radiograph, leukocytosis, purulent secretions, and/or fever, following guidelines.2 Because our data collection was retrospective, to limit false positives, we decided to restrict the population to patients with VAP diagnosis in which the tracheal aspirate culture resulted positive (count > 104 colony-forming units/mL).

Chest ultrasound examinations were performed by intensivists skilled in chest ultrasonography. The ICU of the ED of Careggi University Hospital started to routinely use chest ultrasonography in 2008.3 The competence acquired permitted a reduction in chest radiographs and CT scans,4 the ability to monitor evolution of pulmonary diseases in extracorporeal membrane oxygenation patients,5 and the ability to organize training events.

Dosage of soluble triggering receptor expressed on myeloid cells-1 in BAL fluid is not available in our center. We decided to use plasmatic concentration of procalcitonin as a sepsis indicator instead of leukocyte count. The observation of our colleagues is correct and confirmed in our study, in which procalcitonin became predictive in VAP diagnosis only when associated with pulmonary infiltrates at chest echography (Tables 5 and 6 in our study1).

References

Zagli G, Cozzolino M, Terreni A, Biagioli T, Caldini AL, Peris A. Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new score based on procalcitonin and chest echography. Chest. 2014;146(6):1578-1585. [CrossRef] [PubMed]
 
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416. [CrossRef] [PubMed]
 
Tutino L, Cianchi G, Barbani F, Batacchi S, Cammelli R, Peris A. Time needed to achieve completeness and accuracy in bedside lung ultrasound reporting in intensive care unit. Scand J Trauma Resusc Emerg Med. 2010;18:44-46. [CrossRef] [PubMed]
 
Peris A, Tutino L, Zagli G, et al. The use of point-of-care bedside lung ultrasound significantly reduces the number of radiographs and computed tomography scans in critically ill patients. Anesth Analg. 2010;111(3):687-692. [CrossRef] [PubMed]
 
Cianchi G, Bonizzoli M, Pasquini A, et al. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center. BMC Pulm Med. 2011;11(2):1-9. [PubMed]
 

Figures

Tables

References

Zagli G, Cozzolino M, Terreni A, Biagioli T, Caldini AL, Peris A. Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new score based on procalcitonin and chest echography. Chest. 2014;146(6):1578-1585. [CrossRef] [PubMed]
 
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416. [CrossRef] [PubMed]
 
Tutino L, Cianchi G, Barbani F, Batacchi S, Cammelli R, Peris A. Time needed to achieve completeness and accuracy in bedside lung ultrasound reporting in intensive care unit. Scand J Trauma Resusc Emerg Med. 2010;18:44-46. [CrossRef] [PubMed]
 
Peris A, Tutino L, Zagli G, et al. The use of point-of-care bedside lung ultrasound significantly reduces the number of radiographs and computed tomography scans in critically ill patients. Anesth Analg. 2010;111(3):687-692. [CrossRef] [PubMed]
 
Cianchi G, Bonizzoli M, Pasquini A, et al. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center. BMC Pulm Med. 2011;11(2):1-9. [PubMed]
 
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