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

Felton, T. W., Ahmed, W., White, I. R., van Oort, P., Rattray, N. J. W., Docherty, C., Bannard‐Smith, J., Morton, Ben ORCID: https://orcid.org/0000-0002-6164-2854, Welters, I., McMullan, R., Roberts, S. A., Goodacre, R., Dark, P. M. and Fowler, S. J. (2023) 'Analysis of exhaled breath to identify critically ill patients with ventilator‐associated pneumonia'. Anaesthesia, Vol 78, Issue 6, pp. 712-721.

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Abstract

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 ventilator‐associated 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 ventilator‐associated pneumonia.

Item Type:	Article
Subjects:	WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 202 Pneumonia (General or not elsewhere classified)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1111/anae.15999
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	04 Apr 2023 08:28
Last Modified:	16 May 2023 11:46
URI:	https://archive.lstmed.ac.uk/id/eprint/22235

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