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>Journals >Medicina Crítica >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)

Language: Español
References: 23
Page: 218-224
PDF: 119.59 Kb.


Full text




ABSTRACT

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.


Key words: Semiquantitative procalcitonin, C reactive protein, ventilator-associated pneumonia and severe head injury.


REFERENCIAS

  1. Suleiman GH. Trauma craneoencefálico severo: Parte I. Medicritic 2005;2(7):107-148.

  2. Ewig S, Torres A, El-Ebiary M, Fábregas N, Hernández C, González J, Nicolas J, Soto L. Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia. Am J Respir Crit Care Med 1999;159:188-198.

  3. Rello J, Paiva JA, Baraibar J, Barcenilla F, Bodi M, Castander D, Correa H, Díaz E, Garnacho J, Llorio M, et al. International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-associated Pneumonia. Chest 2001;120:955-970.

  4. Seligman R, Meisner M, Lisboa T, Hertz F, Filippin T, Fachel J, Teixeira P. Decreases in procalcitonin and C-reactive protein are strong predictors of survival in ventilator-associated pneumonia. Critical Care 2006;10.

  5. Meduri GU. Diagnosis and differential diagnosis of ventilator associated pneumonia. Clin Chest Med 1995;16:61-93.

  6. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.

  7. Hunter JD. Ventilator associated pneumonia. Postgrad Med J 2006;82:172-178.

  8. Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: An evidence-based systematic review. Ann Intern Med 2003;138:494-501.

  9. Heyland DK, Cook DJ, Griffith L et al. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Trials Group. Am J Respir Crit Care Med 1999;159:1249-56.

  10. American Thoracic Society Documents. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and Healthcare-associated pneumonia. Am J Respir Crit Care 2005;171:388-416.

  11. Luyt CE, Guerin V, Combes A, Trouillet JL, Ayed SB, Bernard M, Gibert C, Chastre J. Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 2005;171:48-53.

  12. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341:515-518.

  13. Nylen ES, Snider RH Jr, Thompson KA, Rohatgi P, Becker KL. Pneumonitis-associated hyperprocalcitoninemia. Am J Med Sci 1996;312:12-18.

  14. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 1999;3:45-50.

  15. Muller B, Becker KL, Schachinger H, Rickenbacher PR, Huber PR, Zimmerli W, Ritz R. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977-983.

  16. Muller B, Prat C. Markers of acute inflammation in assessing and managing lower respiratory tract infections: focus on procalcitonin. Clin Microbiol Infect 2006;suppl 9:8-16.

  17. Orrego L, Pérez M, Pérez Y, Cheyre J, Mardones R. Valores plasmáticos de proteína C reactiva (PCR) en cirugía ortopédica electiva. Rev Méd Chile 2005;133:1341-1348.

  18. Torrabadella de Reynoso P, Pérez-Moltó H. La proteína C reactiva en los tiempos de la medicina molecular. Med Clin (Barc) 2005;125:775-777. Editorial.

  19. Meisner M, Adina H, Schmidt J. Research. Correlation of procalcitonin and C-reactive protein to inflammation, complications, and outcome during the intensive care unit of multiple-trauma patients. Critical Care 2006;10:R.

  20. Póvoa P, Almeida E et al. C-reactive protein as a marker of ventilator-associated pneumonia resolution: a pilot study. Eur Respira 2005;25(5):804-812.

  21. Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med 2000;26:1193-1200.

  22. Becker KL, Nylen ES, White JC et al. Clinical review 167: procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89:1512–1525.

  23. Pelosi P, Barassi A, Severgnini P et al. Prognostic role of clinical and laboratory criteria to identify early ventilator-associated pneumonia in brain injury. Chest 2008;134:101-108.






>Journals >Medicina Crítica >Year 2009, Issue 4
 

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