CHEST Guidelines-Can-Procalcitonin-and-Chest-Echography-Be-Used-to-

Can-Procalcitonin-and-Chest-Echography-Be-Used-to-

Pdf Summary

In a recent publication in CHEST, Zagli et al. explored the use of Chest Echography and the Procalcitonin Pulmonary Infection Score (CEPPIS) as diagnostics for ventilator-associated pneumonia (VAP). The authors reported that CEPPIS demonstrates promising prediction effectiveness. However, Feng and Zhang raised several concerns regarding this approach.<br /><br />Firstly, they pointed out the variability in VAP incidence based on different diagnostic criteria. One study by Ego et al. showed that VAP incidence could vary significantly, depending on the criteria or their combinations used for diagnosis. Feng and Zhang questioned how Zagli et al. selected their criteria and assessed their effectiveness given this variability.<br /><br />Secondly, while Zagli et al. replaced chest radiography with chest echography, Feng and Zhang highlighted the extensive training required to accurately detect the sonographic features of VAP. The competency levels required for proficient chest ultrasonography were noted as a challenge, with very few intensivists possessing these skills across North America, Europe, and Asia-Pacific.<br /><br />Thirdly, the use of plasma procalcitonin concentration instead of other indicators, like soluble triggering receptor expressed on myeloid cells-1 in BAL fluid, was questioned. Feng and Zhang argued that procalcitonin has limited predictive value for diagnosing VAP and can be influenced by non-infective factors like trauma or invasive surgeries, causing potential false-positive results. Zagli et al.'s study predominantly included trauma patients within the VAP group, potentially confounding the outcomes.<br /><br />In response, Zagli acknowledged the difficulties in diagnosing VAP, emphasizing that their study adhered to existing guidelines for defining VAP at the time of diagnosis, incorporating criteria such as new infiltrates, leukocytosis, purulent secretions, and/or fever. Despite challenges, their study aimed to explore innovative diagnostic approaches.

Keywords

Chest Echography

Procalcitonin

Pulmonary Infection Score

Ventilator-associated pneumonia

Diagnostic criteria

Sonographic features

Chest ultrasonography

Procalcitonin predictive value

Trauma patients

Innovative diagnostics