CHEST Guidelines-A-New-Score-Based-on-Procalcitonin-and-Chest-Echog

A-New-Score-Based-on-Procalcitonin-and-Chest-Echog

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The document is a correspondence exchange regarding a study by Zagli et al., published in CHEST magazine, which proposes a new scoring system for diagnosing ventilator-associated pneumonia (VAP) using procalcitonin levels and chest echography. Wagner Luis Nedel and colleagues express several concerns about the study. They note an unusual incidence of microbiologically confirmed VAP cases caused by Candida albicans. They argue that diagnosing Candida pneumonia in immunocompetent ICU patients should be avoided and emphasize that such a diagnosis requires histologic evidence. Additionally, they highlight discrepancies in VAP diagnoses made with lung ultrasonography and mention that sonographic diagnostic criteria are still debated and have a level C quality of evidence, implying high uncertainty. They suggest a more comprehensive lung ultrasound diagnostic model could be a better tool.<br /><br />In response, Zagli acknowledges the criticisms and clarifies that their study only included patients with microbiologically confirmed infections to reduce study bias, even acknowledging that this decision might, itself, present limitations. They emphasize that their intent was to examine whether chest echography, as part of a broader score system, could effectively diagnose VAP rather than relying on it alone. They acknowledge that chest echography alone showed low sensitivity (59.3%) for diagnosing VAP compared to the complete score system (80.5%). Zagli’s response emphasizes that the study aims to improve understanding and application of chest echography in diagnosing VAP, though the methodology and interpretation should still be scrutinized and improved.

Keywords

ventilator-associated pneumonia

VAP

procalcitonin levels

chest echography

Candida albicans

lung ultrasonography

diagnostic criteria

microbiologically confirmed infections

Zagli et al.

CHEST magazine