This is an innovative proposal to determine the capacity of molecular analysis of exhaled breath condensate filters (EBCF) to predict ventilator associated pneumonia (VAP) in trauma intensive care unit patients. Based upon preliminary data of 51 patients suspected of having VAP, who underwent bronchoalveolar lavage, we have previously demonstrated a strong correlation between bronchoalveolar lavage and breath condensate quantitative PCR. The goal of this proposal is to understand the changes that occur in the pulmonary microbial community of mechanically ventilated, critically injured adults to support the development of molecular analysis of EBCF to provide an earlier, more sensitive and specific diagnosis of VAP, to enable: 1) earlier recognition of a developing pneumonia, 2) targeted antimicrobial therapy, and 3) assessment of treatment response.

Public Health Relevance

We propose the novel use of exhaled breath condensate filters to non-invasively assess changes in pulmonary flora during mechanical ventilation in trauma patients to predict the development of ventilator associated pneumonia. Quantitative PCR of exhaled breath condensate will be compared with daily time-matched mini- bronchoalveolar lavage (BAL) specimens during mechanical ventilation and with bronchoscopic BAL specimens, obtained to establish the clinical diagnosis of pneumonia. Qualitative and quantitative changes in pathogens will be used to non-invasively predict the development of pneumonia and assess the clinical response to therapy.

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Research Project (R01)
Project #
5R01GM115353-04
Application #
9473059
Study Section
Surgery, Anesthesiology and Trauma Study Section (SAT)
Program Officer
Somers, Scott D
Project Start
2015-07-15
Project End
2019-04-30
Budget Start
2018-05-01
Budget End
2019-04-30
Support Year
4
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Type
DUNS #
079917897
City
Nashville
State
TN
Country
United States
Zip Code
37232
Semler, Matthew W; Self, Wesley H; Wanderer, Jonathan P et al. (2018) Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med 378:829-839