呼出气分析结果用于识别呼吸机相关性肺炎的危重患者

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呼出气分析结果用于识别呼吸机相关性肺炎的危重患者

贵州医科大学麻醉与心脏电生理课题组

翻译：柏雪

编辑：宋雨婷

审校：曹莹

背景

呼吸机相关性肺炎常见于危重患者。呼吸机相关性肺炎可能导致抗生素的过度使用，这反过来又导致细菌耐药性增加。在危重病人呼出的气体中检测挥发性有机化合物，可能有助于早期发现肺炎，避免不必要的抗生素使用。

方法

本试验报道了重症监护中呼吸机相关性肺炎无创诊断的概念验证研究(BRAVo研究)。纳入开始使用或使用抗生素治疗＜24h且患可疑呼吸机相关性肺炎行机械通气的危重患者。对呼出气体和呼吸道样本进行配对采集。呼出的气体用吸附管收集，然后用热解吸气相色谱-质谱法进行分析，以检测挥发性有机化合物。呼吸道样本中病原菌微生物培养结果证实了呼吸机相关性肺炎。对挥发性有机化合物进行单变量和多变量分析，以确定“排除”测试的潜在生物标志物。

结果

96名参与者参加了试验，其中92人的呼出气体可用。在所有测试的化合物中，性能最高的四种候选生物标志物是苯、环己酮、戊醇和十一醛，其在ROC(受试者工作特征曲线)曲线下的面积范围为0.67 ~ 0.77，阴性预测值为85% ~ 88%。

结论

在机械通气危重患者呼出的气体中鉴定出的挥发性有机化合物有望成为一种无创“排除”呼吸机相关性肺炎的有效测试方法。

原始文献来源

T. W. Felton, W. Ahmed, I. R. White, et, al. Analysis of exhaled breath to identify critically ill patients with ventilator-associated pneumonia. Anaesthesia 2023, 78, 712–721.

英文原文

Analysis of exhaled breath to identify critically ill patients with ventilator-associated pneumonia

Summary

Ventilator-associated pneumonia commonly occurs in critically ill patients. Clinical suspicion results in overuse of antibiotics, which in turn promotes antimicrobial resistance. Detection of volatile organic compounds in the exhaled breath of critically ill patients might allow earlier detection of pneumonia and avoid unnecessary antibiotic prescription. We report a proof of concept study for non-invasive diagnosis of ventilatorassociated pneumonia in intensive care (the BRAVo study). Mechanically ventilated critically ill patients commenced on antibiotics for clinical suspicion of ventilator-associated pneumonia were recruited within the first 24 h of treatment. Paired exhaled breath and respiratory tract samples were collected. Exhaled breath was captured on sorbent tubes and then analysed using thermal desorption gas chromatography–mass spectrometry to detect volatile organic compounds. Microbiological culture of a pathogenic bacteria in respiratory tract samples provided confirmation of ventilator-associated pneumonia. Univariable and multivariable analyses of volatile organic compounds were performed to identify potential biomarkers for a `rule-out´ test. Ninety-six participants were enrolled in the trial, with exhaled breath available from 92. Of all compounds tested, the four highest performing candidate biomarkers were benzene, cyclohexanone, pentanol and undecanal with area under the receiver operating characteristic curve ranging from 0.67 to 0.77 and negative predictive values from 85% to 88%. Identified volatile organic compounds in the exhaled breath of mechanically ventilated critically ill patients show promise as a useful non-invasive `rule-out´ test for ventilatorassociated pneumonia.

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文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiLu.米鹭

校对：Michel.米萱

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