RT Journal Article
SR Electronic
T1 Tracheal amylase as a marker for associated ventilator infections in traumatic brain injury patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA2635
DO 10.1183/13993003.congress-2016.PA2635
VO 48
IS suppl 60
A1 Erick Joel Rendón Ramírez
A1 Alexis S. Herrera Guerra
A1 Perla R. Colunga Pedraza
A1 Erika C. Cazares Rendón
A1 Roberto Mercado Longoria
A1 Carolina Ahumada Pamanes
A1 Jorge Martin Llaca Díaz
A1 Claudia Rivera Uribe
A1 Erick W. Renpenning Carrasco
YR 2016
UL http://erj.ersjournals.com/content/48/suppl_60/PA2635.abstract
AB Introduction: Ventilator associated infections(VAI),tracheobronchitis and ventilator-associated pneumonia occurs in 15-20%. Risk factors for VAI in traumatic brain injury(TBI)patients include, endotracheal intubation, Glasgow coma scale(<8) and head surgeries. These risk factors predispose microaspiration and biofilm. Microaspiration markers have been described(pepsin, TREM -1, amylase in alveolar liquid)however, they are high-cost.Objetive: We aim to assess whether the amylase obtained by routinely tracheal aspirate in Intensive Care Unit(ICU) predicts the development of VAI in neurosurgical patients.Methods: We included adult neurosurgical patients, mechanically ventilated without respiratory infection. Normal chest radiograph within 48 hours in ICU were required. Tracheal amylase was measured at 24 and 48 h by routinely sterile aspiration. Patients were followed to determine development of VAI. Clinical scales as CPIS, SOFA, and APACHE II were applied.Results: Sixty patients were enrolled, 27(45%)developed VAI. Clinical scales did not predict nosocomial infection while amylase at 24h and 48h predicted VAI (P=0.001, P<0.001 respectively). Area under the curve (AUC) for 24 hour amylase was 0.84±0.05(95% CI0.71-0.96) for a value of 585 IU/L(sensitivity 84 % specificity 94%). 48h amylase AUC was 0.95 ± 0.05(95% CI 0.86- 0.99) for a value of 364 IU/L (sensitivity 92% specificity 100%).Conclusions: Higher levels of tracheal amylase in the first 24 and 48 hours predicted the development of VAI faster than the currently used scores. Measurement of amylase obtained by routinely tracheal aspiration without bronchoscopy might represent an easy and cheap diagnostic tool predicting VAI.