Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges
Kollef, M. H. What is ventilator-associated pneumonia and why is it important? Respir. Care 50, 714–721 (2005).
Google Scholar
Zolfaghari, P. S. & Wyncoll, D. L. The tracheal tube: gateway to ventilator-associated pneumonia. Crit. Care 15, 310 (2011).
Google Scholar
Safdar, N., Dezfulian, C., Collard, H. R. & Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit. Care Med. 33, 2184–2193 (2005).
Google Scholar
Torres, A. et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia. Eur. Respiratory J. 50, 1700582 (2017).
Google Scholar
Barbier, F., Andremont, A., Wolff, M. & Bouadma, L. Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr. Opin. Pulm. Med. 19, 216–228 (2013).
Google Scholar
Timsit, J. F., Esaied, W., Neuville, M., Bouadma, L. & Mourvllier, B. Update on ventilator-associated pneumonia. F1000Res 6, 2061 (2017).
Google Scholar
Semet, C. The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit. Infect. Prev. Pract. 5, 100320 (2023).
Google Scholar
Fernando, S. M. et al. Diagnosis of ventilator-associated pneumonia in critically ill adult patients-a systematic review and meta-analysis. Intensive Care Med. 46, 1170–1179 (2020).
Google Scholar
Lynch, J. P.III. Hospital-acquired pneumonia: risk factors, microbiology, and treatment. CHEST 119, 373S–384SS (2001).
Google Scholar
Wu, D., Wu, C., Zhang, S. & Zhong, Y. Risk factors of ventilator-associated pneumonia in critically III patients. Front Pharm. 10, 482 (2019).
Google Scholar
ECDC. European Centre for Disease Prevention and Control. European surveillance of healthcare- associated infections in intensive care units – HAI-Net ICU protocol Stockholm: ECDC. (2015).
Chastre, J. & Fagon, J. Y. Ventilator-associated pneumonia. Am. J. Respir. Crit. Care Med. 165, 867–903 (2002).
Google Scholar
Melsen, W. G. et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect. Dis. 13, 665–671 (2013).
Google Scholar
Fabregas, N. et al. Histopathologic and microbiologic aspects of ventilator-associated pneumonia. Anesthesiology 84, 760–771 (1996).
Google Scholar
Craven, D. E. & Hjalmarson, K. I. Ventilator-associated tracheobronchitis and pneumonia: thinking outside the box. Clin. Infect. Dis. 51, S59–S66 (2010).
Google Scholar
Vincent, J. L. et al. The prevalence of nosocomial infection in intensive care units in Europe. results of the European Prevalence of Infection in Intensive Care (EPIC) study. EPIC International Advisory Committee. Jama 274, 639–644 (1995).
Google Scholar
Browne, E. et al. A national survey of the diagnosis and management of suspected ventilator-associated pneumonia. BMJ Open Respir. Res 1, e000066 (2014).
Google Scholar
Rello, J. et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 122, 2115–2121 (2002).
Google Scholar
Hunter, J. D. Ventilator associated pneumonia. Bmj 344, e3325 (2012).
Google Scholar
Li, Y., Liu, C., Xiao, W., Song, T. & Wang, S. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis. Neurocrit Care 32, 272–285 (2020).
Google Scholar
Teixeira, P. J. Z., Seligman, R., Hertz, F., Cruz, D. & Fachel, J. Inadequate treatment of ventilator-associated pneumonia: risk factors and impact on outcomes. J. Hospital Infect. 65, 361–367 (2007).
Google Scholar
Domínguez A. A., Arango M. V. & Torres A. Treatment failure in patients with ventilator-associated pneumonia. Semin. Respir. Crit. Care Med. 27, 104–14 (2006).
Gursel, G., Aydogdu, M., Ozyilmaz, E. & Ozis, T. N. Risk factors for treatment failure in patients with ventilator-associated pneumonia receiving appropriate antibiotic therapy. J. Crit. Care 23, 34–40 (2008).
Google Scholar
Storms, A. D. et al. Rates and risk factors associated with hospitalization for pneumonia with ICU admission among adults. BMC Pulm. Med. 17, 208 (2017).
Google Scholar
Al-Omari, B. et al. Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care. BMC Pulm. Med. 21, 196 (2021).
Google Scholar
Luckraz, H. et al. Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study. J. Intensive Care Soc. 19, 94–100 (2018).
Google Scholar
Mietto, C., Pinciroli, R., Patel, N. & Berra, L. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir. Care 58, 990–1007 (2013).
Google Scholar
Young, P. J., Pakeerathan, S., Blunt, M. C. & Subramanya, S. A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration. Crit. Care Med. 34, 632–639 (2006).
Google Scholar
Carter, E. L. et al. Strategies to prevent ventilation-associated pneumonia: the effect of cuff pressure monitoring techniques and tracheal tube type on aspiration of subglottic secretions: an in-vitro study. Eur. J. Anaesthesiol. 31, 166–171 (2014).
Google Scholar
Niederman, M. S. The clinical diagnosis of ventilator-associated pneumonia. Respir. Care 50, 788–796 (2005). discussion 807-12.
Google Scholar
Jackson, L. & Owens, M. Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults? Br. J. Nurs. 28, 682–689 (2019).
Google Scholar
Goetz, R. L., Vijaykumar, K. & Solomon, G. M. Mucus clearance strategies in mechanically ventilated patients. Front Physiol. 13, 834716 (2022).
Google Scholar
Konrad, F., Schreiber, T., Brecht-Kraus, D. & Georgieff, M. Mucociliary transport in ICU patients. Chest 105, 237–241 (1994).
Google Scholar
Lorente, L., Lecuona, M., Jiménez, A., Mora, M. L. & Sierra, A. Ventilator-associated pneumonia using a heated humidifier or a heat and moisture exchanger: a randomized controlled trial [ISRCTN88724583]. Crit. Care 10, R116 (2006).
Google Scholar
Deem, S. & Treggiari, M. M. New endotracheal tubes designed to prevent ventilator-associated pneumonia: do they make a difference? Respir. Care 55, 1046–1055 (2010).
Google Scholar
Adair, C. G. et al. Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med. 25, 1072–1076 (1999).
Google Scholar
Morris A. C. Management of pneumonia in intensive care. J. Emgy Crit. Care Med. 2 (2018).
Biel, M. A. et al. Reduction of endotracheal tube biofilms using antimicrobial photodynamic therapy. Lasers Surg. Med. 43, 586–590 (2011).
Google Scholar
Delle Rose, D. et al. Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals. Eur. J. Clin. Microbiol Infect. Dis. 35, 1531–1539 (2016).
Google Scholar
Hellyer, T. P. et al. Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia. Thorax 70, 41–47 (2015).
Google Scholar
Azoulay, E. et al. Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest 129, 110–117 (2006).
Google Scholar
Mandelli, M., Mosconi, P., Langer, M. & Cigada, M. IS PNEUMONIA DEVELOPING IN PATIENTS IN INTENSIVE CARE ALWAYS A TYPICAL “NOSOCOMIAL” INFECTION? Lancet 328, 1094–1095 (1986).
Google Scholar
Ben Lakhal, H., M’Rad, A., Naas, T. & Brahmi, N. Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia. Infect. Dis. Rep. 13, 401–410 (2021).
Google Scholar
ATS. 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. 171, 388–416 (2005).
Google Scholar
Giantsou, E. et al. Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria. Intensive Care Med. 31, 1488–1494 (2005).
Google Scholar
Vallés, J. et al. Excess ICU mortality attributable to ventilator-associated pneumonia: the role of early vs late onset. Intensive Care Med. 33, 1363–1368 (2007).
Google Scholar
Restrepo, M. I. et al. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respiratory Care 58, 1220–1225 (2013).
Google Scholar
Khan, R. et al. The impact of onset time on the isolated pathogens and outcomes in ventilator associated pneumonia. J. Infect. Public Health 9, 161–171 (2016).
Google Scholar
Gunalan, A., Sastry, A. S., Ramanathan, V. & Sistla, S. Early- vs late-onset ventilator-associated pneumonia in critically ill adults: comparison of risk factors, outcome, and microbial profile. Indian J. Crit. Care Med. 27, 411–415 (2023).
Google Scholar
TROUILLET, J.-L. et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am. J. Respiratory Crit. Care Med. 157, 531–539 (1998).
Google Scholar
Loughlin, L. et al. Pulmonary aspergillosis in patients with suspected ventilator-associated pneumonia in UK ICUs. Am. J. Respiratory Crit. Care Med. 202, 1125–1132 (2020).
Google Scholar
Huang, L. et al. Viral reactivation in the lungs of patients with severe pneumonia is associated with increased mortality, a multicenter, retrospective study. J. Med Virol. 95, e28337 (2023).
Google Scholar
Hellyer, T. P. et al. Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluation. Lancet Respir. Med. 8, 182–191 (2020).
Google Scholar
Martin-Loeches, I. et al. The importance of airway and lung microbiome in the critically ill. Crit. Care 24, 537 (2020).
Google Scholar
Fernández-Barat, L., López-Aladid, R. & Torres, A. Reconsidering ventilator-associated pneumonia from a new dimension of the lung microbiome. EBioMedicine 60, 102995 (2020).
Google Scholar
Fenn, D. et al. Composition and diversity analysis of the lung microbiome in patients with suspected ventilator-associated pneumonia. Crit. Care (Lond., Engl.) 26, 203 (2022).
Google Scholar
Zakharkina, T. et al. The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia. Thorax 72, 803–810 (2017).
Google Scholar
Torres, A. et al. Pneumonia. Nat. Rev. Dis. Prim. 7, 25 (2021).
Google Scholar
Quinton, L. J., Walkey, A. J. & Mizgerd, J. P. Integrative physiology of pneumonia. Physiological Rev. 98, 1417–1464 (2018).
Google Scholar
Joshi, N., Walter, J. M. & Misharin, A. V. Alveolar macrophages. Cell. Immunol. 330, 86–90 (2018).
Google Scholar
Mikacenic, C. et al. Neutrophil extracellular traps (NETs) are increased in the alveolar spaces of patients with ventilator-associated pneumonia. Crit. Care 22, 358 (2018).
Google Scholar
Cheng, O. Z. & Palaniyar, N. NET balancing: a problem in inflammatory lung diseases. Front. Immunol. 4, 1 (2013).
Google Scholar
Porto, B. N. & Stein, R. T. Neutrophil extracellular traps in pulmonary diseases: too much of a good thing? Front. Immunol. 7, 311 (2016).
Google Scholar
Narasaraju, T. et al. Excessive neutrophils and neutrophil extracellular traps contribute to acute lung injury of influenza pneumonitis. Am. J. Pathol. 179, 199–210 (2011).
Google Scholar
Conway Morris, A. et al. Diagnostic importance of pulmonary interleukin-1beta and interleukin-8 in ventilator-associated pneumonia. Thorax 65, 201–207 (2010).
Google Scholar
Greathouse, K. C. & Hall, M. W. Critical illness-induced immune suppression: current state of the science. Am. J. Crit. Care 25, 85–92 (2016).
Google Scholar
Muszynski, J. A., Thakkar, R. & Hall, M. W. Inflammation and innate immune function in critical illness. Curr. Opin. Pediatr. 28, 267–273 (2016).
Google Scholar
Halbertsma, F. J., Vaneker, M., Scheffer, G. J. & van der Hoeven, J. G. Cytokines and biotrauma in ventilator-induced lung injury: a critical review of the literature. Neth. J. Med. 63, 382–392 (2005).
Google Scholar
Grover, V. et al. A biomarker panel (Bioscore) incorporating monocytic surface and soluble TREM-1 has high discriminative value for ventilator-associated pneumonia: a prospective observational study. PLOS ONE 9, e109686 (2014).
Google Scholar
Horn, K. J., Fulte, S., Yang, M., Lorenz, B. P. & Clark, S. E. Neutrophil responsiveness to IL-10 impairs clearance of Streptococcus pneumoniae from the lungs. J. Leukoc. Biol. 115, 4–15 (2023).
Google Scholar
Fàbregas, N. et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax 54, 867–873 (1999).
Google Scholar
Torres, A., Fábregas, N., Arce, Y. & López-Boado, M. A. Histopathology of ventilator-associated pneumonia (VAP) and its clinical implications. Infection 27, 71–76 (1999).
Google Scholar
Rouby, J. J. et al. Nosocomial bronchopneumonia in the critically ill. histologic and bacteriologic aspects. Am. Rev. Respir. Dis. 146, 1059–1066 (1992).
Google Scholar
Rotstein, C. et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can. J. Infect. Dis. Med Microbiol 19, 19–53 (2008).
Google Scholar
Masterton, R. G. et al. Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for antimicrobial chemotherapy. J. Antimicrob. Chemother. 62, 5–34 (2008).
Google Scholar
Kalil, A. C. et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin. Infect. Dis. 63, e61–e111 (2016).
Google Scholar
Ego, A., Preiser, J. C. & Vincent, J. L. Impact of diagnostic criteria on the incidence of ventilator-associated pneumonia. Chest 147, 347–355 (2015).
Google Scholar
Wang, G., Ji, X., Xu, Y. & Xiang, X. Lung ultrasound: a promising tool to monitor ventilator-associated pneumonia in critically ill patients. Crit. Care 20, 320 (2016).
Google Scholar
Kuti, E. L., Patel, A. A. & Coleman, C. I. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis. J. Crit. Care 23, 91–100 (2008).
Google Scholar
Martin-Loeches, I. et al. Resistance patterns and outcomes in intensive care unit (icu)-acquired pneumonia. validation of European Centre For Disease Prevention And Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms. J. Infect. 70, 213–222 (2015).
Google Scholar
Mackenzie, G. The definition and classification of pneumonia. Pneumonia 8, 14 (2016).
Google Scholar
Mangram, A. J. et al. Trauma-associated pneumonia: time to redefine ventilator-associated pneumonia in trauma patients. Am. J. Surg. 210, 1056–1061 (2015).
Google Scholar
Cavalcanti, M. et al. Risk and prognostic factors of ventilator-associated pneumonia in trauma patients. Crit. Care Med. 34, 1067–1072 (2006).
Google Scholar
Niederman, M. S. Hospital-acquired pneumonia, health care-associated pneumonia, ventilator-associated pneumonia, and ventilator-associated tracheobronchitis: definitions and challenges in trial design. Clin. Infect. Dis. 51, S12–S17 (2010).
Google Scholar
Horan, T. C., Andrus, M. & Dudeck, M. A. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am. J. Infect. Control 36, 309–332 (2008).
Google Scholar
Self, W. H., Courtney, D. M., McNaughton, C. D., Wunderink, R. G. & Kline, J. A. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am. J. Emerg. Med. 31, 401–405 (2013).
Google Scholar
Nseir, S. et al. Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome. Eur. Respiratory J. 20, 1483–1489 (2002).
Google Scholar
Agrafiotis, M., Siempos, I. I. & Falagas, M. E. Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: Systematic review and meta-analysis. Respiratory Med. 104, 325–336 (2010).
Google Scholar
Craven, D. E., Hudcova, J. & Lei, Y. Diagnosis of ventilator-associated respiratory infections (VARI): microbiologic clues for tracheobronchitis (VAT) and pneumonia (VAP). Clin. Chest Med. 32, 547–557 (2011).
Google Scholar
Mahmoud, M., Towe, C. & Fleck, R. J. CT chest under general anesthesia: pulmonary, anesthetic and radiologic dilemmas. Pediatr. Radio. 45, 977–981 (2015).
Google Scholar
Long, L., Zhao, H. T., Zhang, Z. Y., Wang, G. Y. & Zhao, H. L. Lung ultrasound for the diagnosis of pneumonia in adults: A meta-analysis. Med. (Baltim.) 96, e5713 (2017).
Google Scholar
Lichtenstein, D. et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100, 9–15 (2004).
Google Scholar
Nonami, S. et al. Incidence of adverse events associated with the in-hospital transport of critically ill patients. Crit. Care Explor 4, e0657 (2022).
Google Scholar
Jia, L., Wang, H., Gao, Y., Liu, H. & Yu, K. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Crit. Care 20, 12 (2016).
Google Scholar
Beckmann, U., Gillies, D. M., Berenholtz, S. M., Wu, A. W. & Pronovost, P. Incidents relating to the intra-hospital transfer of critically ill patients. Intensive Care Med. 30, 1579–1585 (2004).
Google Scholar
Delrue L., et al. Difficulties in the interpretation of chest radiography. Springer; 2011).
Chavez, M. A. et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir. Res 15, 50 (2014).
Google Scholar
Cardinale, L., Volpicelli, G., Lamorte, A. & Martino, J. Revisiting signs, strengths and weaknesses of standard chest radiography in patients of acute dyspnea in the emergency department. J. Thorac. Dis. 4, 398–407 (2012).
Google Scholar
Staub, L. J., Biscaro, R. R. M. & Maurici, R. Accuracy and applications of lung ultrasound to diagnose ventilator-associated pneumonia: a systematic review. J. Intensive Care Med. 33, 447–455 (2018).
Google Scholar
Lichtenstein, D. A. BLUE-Protocol and FALLS-Protocol: two applications of lung ultrasound in the critically ill. Chest 147, 1659–1670 (2015).
Google Scholar
Mongodi, S. et al. Lung ultrasound for early diagnosis of ventilator-associated pneumonia. Chest 149, 969–980 (2016).
Google Scholar
Bouhemad, B., Dransart-Rayé, O., Mojoli, F. & Mongodi, S. Lung ultrasound for diagnosis and monitoring of ventilator-associated pneumonia. Ann. Transl. Med. 6, 418 (2018).
Google Scholar
Xirouchaki, N. et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 37, 1488–1493 (2011).
Google Scholar
Pradhan, S., Shrestha, P. S., Shrestha, G. S. & Marhatta, M. N. Clinical impact of lung ultrasound monitoring for diagnosis of ventilator associated pneumonia: a diagnostic randomized controlled trial. J. Crit. Care 58, 65–71 (2020).
Google Scholar
Gaber, S., Tayeh, O., Wahab, K. A., Mohamed, N. & Essawy, T. Early detection of ventilator-associated pneumonia: bedside tools. Egypt. J. Crit. Care Med. 7, 74–79 (2020).
Nafae, R., Eman, S. R., Mohamad, N. A., El-Ghamry, R. & Ragheb, A. S. Adjuvant role of lung ultrasound in the diagnosis of pneumonia in intensive care unit-patients. Egypt. J. Chest Dis. Tuberculosis 62, 281–285 (2013).
Google Scholar
Masterton, R. et al. Hospital-acquired pneumonia guidelines in Europe: a review of their status and future development. J. Antimicrob. Chemother. 60, 206–213 (2007).
Google Scholar
Berton, D. C., Kalil, A. C. & Teixeira, P. J. Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia. Cochrane Database Syst. Rev. 2014, Cd006482 (2014).
Google Scholar
Koulenti, D. et al. Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units. Crit. Care Med. 37, 2360–2368 (2009).
Google Scholar
Bonvento, B. et al. Non-directed bronchial lavage is a safe method for sampling the respiratory tract in critically ill patient. J. Intensive Care Soc. 20, 237–241 (2019).
Google Scholar
Perkins, G. D. et al. Safety and tolerability of nonbronchoscopic lavage in ARDS. Chest 127, 1358–1363 (2005).
Google Scholar
Flanagan, P. et al. The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages. Intensive care Med. 26, 20–30 (2000).
Google Scholar
Shorr, A. F., Sherner, J. H., Jackson, W. L. & Kollef, M. H. Invasive approaches to the diagnosis of ventilator-associated pneumonia: a meta-analysis. Crit. Care Med. 33, 46–53 (2005).
Google Scholar
Monard, C. et al. Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia. Crit. Care 24, 434 (2020).
Google Scholar
Maataoui, N. et al. Impact of rapid multiplex PCR on management of antibiotic therapy in COVID-19-positive patients hospitalized in intensive care unit. Eur. J. Clin. Microbiol. Infect. Dis. 40, 2227–2234 (2021).
Google Scholar
Srivastava, S. et al. Utility of a multiplex pathogen detection system directly from respiratory specimens for treatment and diagnostic stewardship. Microbiol Spectr. 12, e0375923 (2024).
Google Scholar
Vaz, A. P. et al. [Positive bronchoalveolar lavage and quantitative cultures results in suspected late-onset ventilator associated penumonia evaluation-retrospective study]. Rev. Port. Pneumol. 17, 117–123 (2011).
Google Scholar
Fleig, V., Brenck, F., Wolff, M. & Weigand, M. A. Scoring systems in intensive care medicine: principles, models, application and limits. Anaesthesist 60, 963–974 (2011).
Google Scholar
Oprita B., Aignatoaie B., Gabor-Postole D. A. Scores and scales used in emergency medicine. practicability in toxicology. J Med Life. 2014; 7 Spec No. 3(Spec Iss 3):4-7.
Bouch, D. C. & Thompson, J. P. Severity scoring systems in the critically ill. Continuing Educ. Anaesth. Crit. Care Pain. 8, 181–185 (2008).
Google Scholar
Shan, J., Chen, H. L. & Zhu, J. H. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respir. Care 56, 1087–1094 (2011).
Google Scholar
Pugin, J. et al. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am. Rev. Respir. Dis. 143, 1121–1129 (1991).
Google Scholar
Schurink, C. A. M. et al. Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med. 30, 217–224 (2004).
Google Scholar
Gaudet, A. et al. Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia. Ann. Intensive Care 10, 101 (2020).
Google Scholar
Zilberberg, M. D. & Shorr, A. F. Ventilator-associated pneumonia: the clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin. Infect. Dis. 51, S131–S135 (2010). Suppl 1.
Google Scholar
Strimbu, K. & Tavel, J. A. What are biomarkers? Curr. Opin. HIV AIDS 5, 463–466 (2010).
Google Scholar
Palazzo, S. J., Simpson, T. & Schnapp, L. Biomarkers for ventilator-associated pneumonia: review of the literature. Heart Lung 40, 293–298 (2011).
Google Scholar
WHO. World Health Organization. Environmental Health Criteria 222. Biomarkers In Risk Assessment: Validity And Validation Geneva 2001; (2021).
Kumar, A. & Lodha, R. Biomarkers for diagnosing ventilator associated pneumonia: is that the way forward? Indian J. Pediatrics 85, 411–412 (2018).
Google Scholar
Tekerek, N. U., Akyildiz, B. N., Ercal, B. D. & Muhtaroglu, S. New biomarkers to diagnose ventilator associated pneumonia: pentraxin 3 and surfactant protein D. Indian J. Pediatrics 85, 426–432 (2018).
Google Scholar
Xu C., Li S., Wang Y., Zhang M., Zhou M. Biomarkers in intensive care unit infections, friend or foe? J. Crit. Care Med. 40, 465–475 (2019).
Hellyer, T. P. The evaluation of a biomarker-based exclusion of ventilator-associated pneumonia to improve antibiotic stewardship. a multi-centre validation study and randomised controlled trial. J. Intensive Care Soc. 20, 245–247 (2019).
Charles, P. E. et al. Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report. BMC Infect. Dis. 9, 49 (2009).
Google Scholar
Müller, F. et al. Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial. Chest 138, 121–129 (2010).
Google Scholar
Luyt, C. E. et al. Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med. 34, 1434–1440 (2008).
Google Scholar
Dallas, J. et al. Diagnostic utility of plasma procalcitonin for nosocomial pneumonia in the intensive care unit setting. Respir. Care 56, 412–419 (2011).
Google Scholar
Ramirez, P. et al. Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia. Eur. Respir. J. 31, 356–362 (2008).
Google Scholar
Duflo, F. et al. Alveolar and serum procalcitonin: diagnostic and prognostic value in ventilator-associated pneumonia. Anesthesiology 96, 74–79 (2002).
Google Scholar
Tanrıverdi, H. et al. Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia. Ann. Thorac. Med. 10, 137–142 (2015).
Google Scholar
Jensen, J. U. et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit. Care Med. 39, 2048–2058 (2011).
Google Scholar
Bopp, C. et al. Soluble TREM-1 is not suitable for distinguishing between systemic inflammatory response syndrome and sepsis survivors and nonsurvivors in the early stage of acute inflammation. Eur. J. Anaesthesiol. 26, 504–507 (2009).
Google Scholar
Bouchon, A., Dietrich, J. & Colonna, M. Cutting edge: inflammatory responses can be triggered by TREM-1, a novel receptor expressed on neutrophils and monocytes. J. Immunol. 164, 4991–4995 (2000).
Google Scholar
Palazzo, S. J., Simpson, T. A., Simmons, J. M. & Schnapp, L. M. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic marker of ventilator-associated pneumonia. Respir. Care 57, 2052–2058 (2012).
Google Scholar
Anand, N. J., Zuick, S., Klesney-Tait, J. & Kollef, M. H. Diagnostic implications of soluble triggering receptor expressed on myeloid cells-1 in BAL fluid of patients with pulmonary infiltrates in the ICU. Chest 135, 641–647 (2009).
Google Scholar
Determann, R. M. et al. Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during development of ventilator-associated pneumonia. Intensive Care Med. 31, 1495–1500 (2005).
Google Scholar
Horonenko, G. et al. Soluble triggering receptor expressed on myeloid cell-1 is increased in patients with ventilator-associated pneumonia: a preliminary report. Chest 132, 58–63 (2007).
Google Scholar
Gibot, S. et al. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N. Engl. J. Med. 350, 451–458 (2004).
Google Scholar
Torres, A., Artigas, A. & Ferrer, R. Biomarkers in the ICU: less is more? no. Intensive Care Med. 47, 97–100 (2021).
Google Scholar
van de Sande, D., van Genderen, M. E., Huiskens, J., Gommers, D. & van Bommel, J. Moving from bytes to bedside: a systematic review on the use of artificial intelligence in the intensive care unit. Intensive Care Med. 47, 750–760 (2021).
Google Scholar
Liang, Y. et al. Early prediction of ventilator-associated pneumonia in critical care patients: a machine learning model. BMC polm. 22, 250 (2022).
Becker J., et al. Artificial intelligence-based detection of pneumonia in chest radiographs. Diagnostics (Basel). 12, 1465 (2022).
Chumbita M., et al. Can artificial intelligence improve the management of pneumonia?. J. Clin. Med. 9, 248 (2020).
Kermany, D. S. et al. Identifying medical diagnoses and treatable diseases by image-based deep learning. Cell 172, 1122–31.e9 (2018).
Google Scholar
Stephen, O., Sain, M., Maduh, U. J. & Jeong, D.-U. An efficient deep learning approach to pneumonia classification in healthcare. J. Healthc. Eng. 2019, 4180949 (2019).
Google Scholar
Heckerling, P. S., Gerber, B. S., Tape, T. G. & Wigton, R. S. Prediction of community-acquired pneumonia using artificial neural networks. Med. Decis. Mak. 23, 112–121 (2003).
Google Scholar
Hwang, E. J. et al. Deep learning for chest radiograph diagnosis in the emergency department. Radiology 293, 573–580 (2019).
Google Scholar
Giang, C. et al. Predicting ventilator-associated pneumonia with machine learning. Med. (Baltim.) 100, e26246 (2021).
Google Scholar
Bardossy, A. C., Zervos, J. & Zervos, M. Preventing hospital-acquired infections in low-income and middle-income countries: impact, gaps, and opportunities. Infect. Dis. Clin. North Am. 30, 805–818 (2016).
Google Scholar
Bonell, A. et al. A systematic review and meta-analysis of ventilator-associated pneumonia in adults in asia: an analysis of national income level on incidence and etiology. Clin. Infect. Dis. 68, 511–518 (2018).
Google Scholar
Arabi, Y., Al-Shirawi, N., Memish, Z. & Anzueto, A. Ventilator-associated pneumonia in adults in developing countries: a systematic review. Int J. Infect. Dis. 12, 505–512 (2008).
Google Scholar
Mathai, A. S., Phillips, A., Kaur, P. & Isaac, R. Incidence and attributable costs of ventilator-associated pneumonia (VAP) in a tertiary-level intensive care unit (ICU) in northern India. J. Infect. Public Health 8, 127–135 (2015).
Google Scholar
Sanders, S., Doust, J. & Glasziou, P. A Systematic review of studies comparing diagnostic clinical prediction rules with clinical judgment. PLOS ONE 10, e0128233 (2015).
Google Scholar
Fine, M. J. et al. The hospital admission decision for patients with community-acquired pneumonia. results from the pneumonia patient outcomes research team cohort study. Arch. Intern Med. 157, 36–44 (1997).
Google Scholar
Lim, W. S. et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58, 377–382 (2003).
Google Scholar
Ewig, S. et al. Prognostic analysis and predictive rule for outcome of hospital-treated community-acquired pneumonia. Eur. Respir. J. 8, 392–397 (1995).
Google Scholar
Spindler, C. & Ortqvist, A. Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia. Eur. Respir. J. 28, 816–823 (2006).
Google Scholar
link
