CHEST Guidelines-Response_chest

Response_chest_13 (2)

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In a recent correspondence exchanged between Dr. Wagner Luis Nedel and Dr. Giovanni Zagli published in CHEST, a discussion took place regarding the diagnosis of ventilator-associated pneumonia (VAP) using a score based on procalcitonin levels and chest echography. Dr. Nedel and colleagues raised concerns about the potential misdiagnosis of VAP, particularly involving Candida albicans, which they argue is rarely a true pathogen in immunocompetent ICU patients and often a result of airway colonization. They also questioned the use of lung ultrasonography, especially in trauma patients, as it might give false indications of pneumonia due to conditions like pulmonary contusion.<br /><br />Dr. Zagli responded, underlining that their study focused on microbiologically confirmed infections and acknowledged the concerns about relying on chest ultrasonography alone. He emphasized the low sensitivity of echography as a standalone diagnostic tool for VAP, compared to its use within a more comprehensive scoring system, which includes additional diagnostic criteria. The study found that using a multi-faceted approach improved diagnostic sensitivity from 59.3% with echography alone to 80.5% with the full score system. Dr. Zagli defended their approach of integrating chest echography into a larger diagnostic model to enhance accuracy.<br /><br />The correspondence underscores the complexity and ongoing debate in diagnosing VAP, stressing the need for consistent and comprehensive criteria, and possibly offering a more robust method combining procalcitonin levels with chest ultrasound findings for better diagnostic accuracy in clinical settings. Both parties agree on the potential benefits of such integrated diagnostic scores, although further validation and study remain necessary.

Keywords

ventilator-associated pneumonia

VAP diagnosis

procalcitonin levels

chest echography

Candida albicans

lung ultrasonography

pulmonary contusion

diagnostic sensitivity

integrated diagnostic scores

clinical settings