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Giovanni Zagli, MD, PhD
Author and Funding Information

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

CORRESPONDENCE TO: Giovanni Zagli, MD, PhD, Department of Anesthesia and Intensive Care Unit, 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):e109-e110. doi:10.1378/chest.14-2802
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To the Editor:

I thank Dr Nedel and colleagues for their interest and criticisms on our recent article in CHEST.1 In our retrospective study, we decided to consider only patients with microbiologically confirmed infection to limit the bias of the study design. This decision might represent a limit itself, as correctly suggested by Dr Nedel and colleagues, but, in our opinion, the low number of patients with Candida in tracheal aspirate cultures should not influence the potential value of the complete score proposed.2

As appropriately underlined by Dr Nedel and colleagues, chest echography is still debated and studied in literature.3 We also previously reported experience in which patients preferring chest ultrasonography to traditional diagnostic imaging were followed.4,5 In our article,1 we tried to verify whether a diagnosis of ventilator-associated pneumonia (VAP) could have been made not only with chest echography, but also using chest echography in a more complex score system. In fact, as we reported in Table 5 in our article,1 sensitivity of chest echography alone in VAP diagnosis had a quite low sensitivity (59.3%) if compared with the complete score (80.5%). These data not only confirm the correct observation made by Dr Nedel and colleagues, but also confirm that a score, composed of different tools, should be preferred instead of a single finding in VAP diagnosis.

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]
 
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]
 
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]
 
Peris A, Zagli G, Barbani F, et al. The value of lung ultrasound monitoring in H1N1 acute respiratory distress syndrome. Anaesthesia. 2010;65(3):294-297. [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]
 

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]
 
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]
 
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]
 
Peris A, Zagli G, Barbani F, et al. The value of lung ultrasound monitoring in H1N1 acute respiratory distress syndrome. Anaesthesia. 2010;65(3):294-297. [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]
 
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