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.
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.
| 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 |
