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A New Score Based on Procalcitonin and Chest Echography for Diagnosis of Ventilator-Associated PneumoniaNew Ventilator-Associated Pneumonia Score: When? How? For Whom? FREE TO VIEW

Wagner Luis Nedel, MD; Vinicius Daudt Morais, MD; Pablo Wanglon Richter, MD
Author and Funding Information

From the Critical Care Unit, Hospital Nossa Senhora da Conceição.

CORRESPONDENCE TO: Wagner Luis Nedel, MD, Av João XXIII, 525, 801E, 91060-100, Porto Alegre/RS, Brazil; e-mail: wagnernedel@uol.com.br


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have 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):e109. doi:10.1378/chest.14-2523
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Published online
To the Editor:

We read with great interest the study published by Zagli et al1 in a recent issue of CHEST (December 2014). In spite of originality and new insights concerning diagnosis of ventilator-associated pneumonia (VAP), some issues must be considered. First, seven Candida albicans microbiologically confirmed VAP cases is quite an unusual incidence for this pathogen. Diagnosis of Candida pneumonia should be abandoned in ICU setting when immunocompetent subjects are considered.2 Moreover, fungal airway colonization is a frequent finding in patients submitted to mechanical ventilation, and a Candida VAP diagnosis can only be firmly established based on histologic proof. Currently, some discrepancies are found in VAP diagnosis made by lung ultrasonography. Although wide exclusion criteria permitted a refinement of study population (lowering external applicability), the inclusion of trauma patients can be concealing consolidations not related to pneumonia, especially in patients with pulmonary contusion.3 Although based on consensus recommendations, the sonographic pneumonia diagnostic criteria are still controversial. As a matter of fact, it is level C quality of evidence (ie, “any estimate of effect or accuracy is very uncertain”).4 An interstitial pattern (B lines) does not exclude an infectious cause for lung damage—a corollary of radiographic infiltrates presented in the formal VAP diagnosis—and it was not clarified in the present study. Thus, a model of lung ultrasound diagnosis based in a comprehensive score, as previously described,5 should be a more promising tool.

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]
 
Hamet M, Pavon A, Dalle F, et al. Candidaspp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia. Intensive Care Med. 2012;38(8):1272-1279. [CrossRef] [PubMed]
 
Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG. Chest ultrasonography in lung contusion. Chest. 2006;130(2):533-538. [CrossRef] [PubMed]
 
Volpicelli G, Elbarbary M, Blaivas M, et al; International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577-591. [CrossRef] [PubMed]
 
Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010;38(1):84-92. [CrossRef] [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]
 
Hamet M, Pavon A, Dalle F, et al. Candidaspp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia. Intensive Care Med. 2012;38(8):1272-1279. [CrossRef] [PubMed]
 
Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG. Chest ultrasonography in lung contusion. Chest. 2006;130(2):533-538. [CrossRef] [PubMed]
 
Volpicelli G, Elbarbary M, Blaivas M, et al; International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577-591. [CrossRef] [PubMed]
 
Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010;38(1):84-92. [CrossRef] [PubMed]
 
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