PDF(Pubmed)
Abstract：
Ventilator-associated pneumonia (VAP) is common in Pediatric Intensive Care Units. Although early detection is crucial, current diagnostic methods are not definitive. This study aimed to identify lung ultrasound (LUS) findings and procalcitonin (PCT) values in pediatric patients with VAP to create a new early diagnosis score combined with the Clinical Pulmonary Infection Score (CPIS), the CPIS-PLUS score. Prospective longitudinal and interventional study. Pediatric patients with suspected VAP were included and classified into VAP or non-VAP groups, based on Centers of Disease Control (CDC) criteria for the final diagnosis. A chest-X-ray (CXR), LUS, and blood test were performed within the first 12 h of admission. CPIS score was calculated. A total of 108 patients with VAP suspicion were included, and VAP was finally diagnosed in 51 (47%) patients. CPIS-PLUS showed high accuracy in VAP diagnosis with a sensitivity (Sn) of 80% (95% CI 65-89%) and specificity (Sp) of 73% (95% CI 54-86%). The area under the curve (AUC) resulted in 0.86 for CPIS-PLUS vs. 0.61 for CPIS. In conclusion, this pilot study showed that CPIS-PLUS could be a potential and reliable tool for VAP early diagnosis in pediatric patients. Internal and external validations are needed to confirm the potential value of this score to facilitate VAP diagnosis in pediatric patients.
摘要：
呼吸机相关性肺炎（VAP）在儿科重症监护病房中很常见。尽管早期发现至关重要，目前的诊断方法还不确定。这项研究旨在确定小儿VAP患者的肺部超声（LUS）结果和降钙素原（PCT）值，以创建新的早期诊断评分结合临床肺部感染评分（CPIS）。CPIS-PLUS得分。前瞻性纵向和介入研究。纳入疑似VAP的儿科患者，并将其分为VAP或非VAP组。根据疾病控制中心（CDC）的最终诊断标准。胸部X光片(CXR),LUS,在入院的前12小时内进行血液检查。计算CPIS评分。共纳入108例怀疑有VAP的患者，最终在51例（47％）患者中诊断出VAP。CPIS-PLUS在VAP诊断中显示出很高的准确性，敏感性（Sn）为80％（95％CI65-89％），特异性（Sp）为73％（95％CI54-86％）。曲线下面积（AUC）导致CPIS-PLUS与CPIS为0.61。总之,这项初步研究表明,CPIS-PLUS可能是儿科患者VAP早期诊断的一种潜在且可靠的工具.需要进行内部和外部验证以确认该评分的潜在价值，以促进儿科患者的VAP诊断。
