CHEST Guidelines-Response

Response_chest (3)

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In a correspondence to the journal CHEST, Xia Feng and Jian-yong Zhang respond to an article by Zagli et al., which proposed a new score combining procalcitonin levels and chest echography for diagnosing ventilator-associated pneumonia (VAP). Feng and Zhang express concerns over the diagnostic criteria's variability and query how Zagli et al. settled on theirs, given that VAP incidence rates fluctuate widely based on different diagnostic standards. They also question the replacement of chest radiography with echography due to the significant training required for accurate interpretation, suggesting that not all intensivists possess the necessary expertise in ultrasonography. Additionally, they express skepticism about using procalcitonin levels as a marker due to its limited predictive value and the potential for false positives influenced by non-infective factors like trauma, which predominates in the studied VAP group.<br /><br />In his response, Giovanni Zagli acknowledges these diagnostic challenges and details the retrospective nature of their study, which focused on patients with positive tracheal aspirate cultures to minimize false positives. He clarifies that chest ultrasound exams were conducted by skilled intensivists at Careggi University Hospital, where ultrasound has been routinely used since 2008 to reduce reliance on chest radiographs and CT scans. Zagli further explains the choice of procalcitonin over other markers like soluble triggering receptor due to unavailability and emphasizes its effectiveness only when used alongside chest echography findings for diagnosing VAP. The response suggests a contextual application of their methodology within existing resource constraints and acknowledges both the limitations and strengths of the proposed diagnostic approach.

Keywords

ventilator-associated pneumonia

VAP

procalcitonin

chest echography

diagnostic criteria

ultrasonography

intensivists

tracheal aspirate cultures

chest ultrasound

diagnostic methodology