>Year 2009, Issue 4
Jiménez CCM, Bracamontes MRG, Reyes MM
Utility of the procalcitonin in diagnosis early of ventilator associated pneumonia, in severe head injury
Rev Asoc Mex Med Crit y Ter Int 2009; 23 (4)
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The present work of investigation evaluates the utility of the semiquantitative procalcitonin test in diagnostic early of the ventilator-associated pneumonia in the patient with severe head injury
Objectives: To determine if the semiquantitative procalcitonin is a method for the early diagnostic of the ventilator-associated pneumonia in the patient with severe head injury, compared with the determination of C reactive protein. To determine if the semiquantitative procalcitonin allows the therapeutic early beginning of the antimicrobial ventilator-associated pneumonia in the patient with severe head injury.
Design: Prospective, comparative, longitudinal, observational study.
Site: Intensive therapy of the State Center of Trauma of the Hospital of High Specialty «Dr. Gustavo A. Rovirosa Pérez».
Patients: 55 men (84%) and 10 women studied to 65 patients (16%), that entered the Unit of Intensive Care by severe head injury and required mechanical ventilation, from these excluded 12 that passed away in the first 72 hours by cerebral death. The patients including were 53 and they studied during a period of 12 months.
Main measurements and results: To the 53 patients including with severe head injury and mechanical ventilation, serial tests of semiquantitative procalcitonin were made to him and C Reactive Protein, to the 6 hours of the entrance and every 24 hours until making in average 5 to 6 determinations. It was taken as point of positive cut for ventilator-associated pneumonia for the semiquantitative procalcitonin (0.5 ng/mL) and for C Reactive Protein (10 mg/dL), and the time interval between the elevation of these tests and the presence of clinical criteria and laboratory for ventilator-associated pneumonia. The semiquantitative PCT showed 77.27% Sensitivity of and Specificity of 77.78%, the PCR 93.18% Sensitivity of and Specificity of 22.22%. With the ROC curve (Receiver-Operating Characteristic) the area under the curve for the PCT was of 77% and for PCR 57%. The time average of elevation of the semiquantitative PCT and the presence of ventilator-associated pneumonia was of 1.1 day and for the PCR of 1.8 days.
Conclusions: The early diagnosis of ventilator-associated pneumonia (NAV) in patients with severe head injury can be made with inflammatory markers like PCT and PCR, allowing no single the advance use of antimicrobial but in addition saving in days, or the non use in the cases with negative results in correlation with the clinic.
||Semiquantitative procalcitonin, C reactive protein, ventilator-associated pneumonia and severe head injury.
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>Year 2009, Issue 4