Negative Predictive Value of Computed Tomography Pulmonary Angiography With Indirect Computed Tomography Venography in Intensive Care Unit Patients

OBJECTIVE Our primary objective was to determine the utility of procalcitonin (PCT) in detection of bacterial coinfection in children < 5 years admitted to the pediatric intensive care unit with viral lower respiratory tract infection (LRTI). METHODS Electronic medical record review of children < 5 years admitted to the pediatric intensive care unit with a viral LRTI who also had at least 1 PCT concentration measurement. RESULTS Seventy-five patients were admitted to the intensive care unit and met the inclusion criteria for this investigation. The PCT threshold concentrations of 0.9, 1, 1.4, and 2 ng/mL were found to be statistically significant in determining the presence of a bacterial coinfection. The PCT concentration with the most utility was 1.4 ng/mL with sensitivity, specificity, positive and negative predictive values of 46%, 83%, 68%, and 76%, respectively. For patients with serial PCTs, the second PCT correctly influenced treatment decisions for 11 of 25 patients (44%). CONCLUSIONS A PCT value of 1.4 ng/mL determined the presence of a bacterial coinfection primarily owing to the high specificity and negative predictive value. Our data add evidence to the relatively high negative predictive value of PCT concentrations in identifying patients with bacterial coinfection, specifically in the case of viral LRTI. In addition, our preliminary data indicate serial PCT measurements may help further influence correct treatment decisions. Prospective, controlled studies are warranted to validate an appropriate PCT threshold concentration to help in identifying bacterial coinfection as well as to further explore the role of serial PCT values in determining the absence or presence of a bacterial coinfection.

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A Novel Test for the Rapid Rule Out of Heparin-Induced Thrombocytopenia Diagnosis in Intensive Care unit patients

Blood ◽

10.1182/blood.v120.21.1119.1119 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1119-1119

Author(s):

Vassiliki Galea ◽

Francoise Robert ◽

Patrick Van Dreden ◽

Barry J Woodhams ◽

Grigoris T Gerotziafas ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Unfractionated Heparin ◽

Negative Predictive Value ◽

Predictive Value ◽

False Positive ◽

Icu Patients ◽

Predictive Values ◽

Heparin Induced Thrombocytopenia ◽

Positive Results

Abstract Abstract 1119 Introduction Diagnosis of heparin-induced thrombocytopenia (HIT) in intensive care unit (ICU) patients represents a major challenge mainly because both the use of unfractionated heparin and the presence of thrombocytopenia are quite common. Despite the existence of several laboratory tests, accurate and prompt HIT diagnostics remains difficult. The ideal combination of an immunological and a functional test is restrictedto specialized laboratories, due to the complexity of the latter. We are in need of an easy-to-perform, widely accessible, rapid and reliably assay. Aim of the study To prospectively evaluate the performance of the latelar-flow immunoassay STic HIT Expert® (Diagnostica Stago, France) for the detection in ICU patients suspected for HIT. Patients-methods Seventy two patients (40 males/32 females) hospitalized in ICU from January to June 2012 were included. Thirty one patients presented with sepsis, 27 underwent extracorporeal circulation (ECC), 21 were hemodialysed and 3 patients were receiving chemotherapy. Sixty one patients were treated with unfractionated heparin and 11 patients received low molecular weight heparin (LMWH). A 4T's score was performed for all patients. All samples were tested in polyspecific ELISA (Zymutest Hyphen Biomed, Neuville-Sur-Oise, France), STic HIT Expert® (Diagnostica Stago, France) and serotonin release assay. In case of a positive polyspecific ELISA, IgG, IgM et IgA isotypes were also performed. Sensitivity, specificity, positive and negative predictive values (PPV an NPV) of STic HIT Expert® were determined against SRA. Results All three tests (polyspecific ELISA, STic HIT Expert®, SRA) were negative in forty patients and had a low HIT suspicion (4T's score: 0–4). In 10 out of 72 patients polyspecific all immunological tests and SRA were positive and HIT suspicion was intermediate or high (4T's score: 4–7). In 9 patients, ELISA tests and STic HIT Expert® were positive but SRA was negative. These patients had a low HIT suspicion (4T's score: 1–4) and underwent ECC (6 out of 9), were hemodialyzed (3 out of 9) or complicated by sepsis (2 out of 9). On the other hand 13 out of 72 patients had ELISA tests positive but STic HIT Expert® and SRA negative. The prevalence of sepsis was high in these patients (8 out of 13), 3 patients underwent ECC and one patient was hemodialysed. STic HIT Expert®, polyspecific and IgG specific ELISA had an excellent sensitivity and negative predictive value at 100%. Moreover STic HIT Expert® was associated with a smaller number of false positive results than the ELISAs. (Table) Conclusion STic HIT Expert® has an excellent performance with a high negative predictive value (100%) and a satisfactory specificity (85%). Less false positive results are detected with STic HIT Expert® than with polyspecific and IgG specific ELISAs. Moreover the test offers a shorter turnaround than ELISA tests and is an easy-to-use single sample test. These characteristics could help avoid HIT over diagnosis in ICU patients. Disclosures: No relevant conflicts of interest to declare.

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Evaluation of a Candida Antigen Detection Method (Cand-Tec): Experience from a University Teaching Hospital

Canadian Journal of Infectious Diseases ◽

10.1155/1992/725104 ◽

1992 ◽

Vol 3 (4) ◽

pp. 167-172 ◽

Cited By ~ 1

Author(s):

Todd J Anderson ◽

Heather E Bryant ◽

Deirdre L Church

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Invasive Candidiasis ◽

Predictive Value ◽

High Probability ◽

University Teaching ◽

Candidal Infection

The usefulness of a rapid latex agglutination method for the detection of Candida antigen (Cand-Tec; Ramco Laboratories. Texas) was retrospectively assessed in a university teaching hospital over a one year period. Patients were enrolled when the managing physician requested Cand-Tec testing for confirmation of possible invasive candidal infection. The majority of patients were critically ill; 56% were in the intensive care unit, and 30% subsequently died. Analyses were available from 79 patients and 125 samples. Thirty-three patients were diagnosed as having either definite invasive candidiasis or a high probability of infection based upon clinical, microbiological and tissue criteria. The sensitivity and specificity of Candida antigen detection was determined for doubling titres ≥1:4 to ≥1:16. If a titre of ≥1:4 was used as the diagnostic cut-off level for definite candidal infection, overall sensitivity and specificity were 77% and 69%, respectively, while the positive predictive value was 48%, and the negative predictive value 89%. When patients with a high probability of invasive candidal infection were included in analyses for a cut-off titre of ≥1:4, overall sensitivity and specificity were 70% and 69%, respectively, while the positive predictive value was 68%, and the negative predictive value 71%. The usefulness of the Cand-Tec test was not improved further for any subgroup of patients (including those in the intensive care unit), nor by following serial titres in individual patients. In this experience, the Cand-Tec test did not add enough information to include definitively or exclude invasive candidiasis in this high risk general patient population.

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Prognostic Value of Rapid Shallow Breathing Index for Weaning Success in Intensive Care Unit Patients under Mechanical Ventilation

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i1.48006 ◽

2020 ◽

Vol 6 (1) ◽

pp. 9-14

Author(s):

Md Sirajul Islam ◽

Md Ali Haider ◽

Uzzwal Kumar Mallick ◽

Mohammad Asaduzzaman ◽

Md Gias Uddin ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Prolonged Mechanical Ventilation ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing

Background: The weaning success in intensive care unit patients under mechanical ventilation is very important. Objective: The purpose of this study was to investigate the efficacy and effects of rapid shallow breathing index (RSBI) in predicting weaning success in patients with prolonged mechanical ventilation more than 48 hours. Methodology: This prospective cohort study was conducted in the Department of Anesthesia, Pain Palliative & Intensive Care Unit of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2014 to December 2015 for a period of two (02) years. Patients on mechanical ventilation more than 48 hours with the age of 18 to 60 years were included in this study. During the weaning process, the arterial blood gases (ABG) values was checked and the patients was separated from mechanical ventilation. After measuring RSBI, patients was separated from mechanical ventilator and given T-piece trial (1 to 4 hours) and finally extubated as per advice of ICU consultant and observed for 48 hours. The patients were divided in two groups low RSBI ≤105 breath/min/L and high RSBI >105 breath/min/L. These patients were prospectively followed up to 48 hours in ICU and HDU. Result: A total of 117 patients were included in this study. The validity of RSBI evaluation for trail failure was correlated by calculating sensitivity, specificity, accuracy, positive and negative predictive values. The sensitivity of RSBI was 54.5% (95% CI 23.38% to 83.25%) and specificity was 82.1% (95% CI 73.43% to 88.85%). However, positive predictive value and negative predictive value were 24.0% (95% CI 13.84% to 38.30%) and 94.6% (95% CI 90.05% to 97.10%) respectively. The accuracy was found 79.5% (95% CI 71.03% to 86.39%). Receiver-operator characteristic (ROC) were constructed using RSBI of the weaning outcome, which gave a RSBI cut off value of ≥88 as the value with a best combination of sensitivity (72.7%) and specificity (61.3%), accuracy (60.7%), positive predictive value (15.7%), negative predictive value (95.5%) for trail failure. Conclusion: In conclusion the efficacy and effects of rapid shallow breathing index is found low sensitivity with high specificity in predicting weaning success in patients with prolonged mechanical ventilation more than 48 hours. Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 9-14

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Comparing the predicted accuracy of PO2\FIO2 ratio with rapid shallow breathing index for successful spontaneous breathing trail in Intensive Care Unit

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.6.788 ◽

2019 ◽

Vol 35 (6) ◽

Author(s):

Dr Aamir Furqan ◽

Dr Shumaila Ali Rai ◽

Dr Liaqat Ali ◽

Dr Rana Altaf Ahmed

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Spontaneous Breathing ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing

Objective: To compare the predicted accuracy of PFR with RSBI for successful spontaneous breathing trail before extubation in intensive care unit. Methods: This cross sectional study was conducted at the ICU of Ch. Pervaiz Ellahi Institute of Cardiology, Multan Medical and Nishtar Medical University Hospital from July, 2017 to January, 2019. PO2/FIO2 and RSBI was measured by a different investigator, before and 20 minutes after the start of SBT. Heart rate, blood pressure and oxygen saturation were continuously measured throughout the trial. Trial outcome was labeled as unsuccessful or successful by the investigator who was blinded to the rapid shallow breathing index and PO2/FiO2 measurements. Patients with SpO2>85%, stable hemodynamics (HR and BP change <20%), stable respiration (RR change <50%), and the absence of (i) signs of labored breathing, (ii) emergence or worsened discomfort, (iii) change in mental status, were labeled as successful in bearing the SBT. Patients were divided into two groups i.e. successful and unsuccessful, gender, Age, GOLD stage, APACHE II score, pCO2, pO2, FiO2 and RSBI score were compared between the two groups after putting all the data in SPSS version 23. Chi square tests and Student’s t-test were used on the continuous data and nominal data, accordingly. The specificity, sensitivity, diagnostic accuracy, negative predictive value and positive predictive value of two threshold values of RSBI and PO2/FiO2 ratio were calculated from the 2X2 contingency tables. Results: RSBI threshold of 130 had 40.4% sensitivity, 51.1% specificity, 55.2% positive predictive value, 36.4% negative predictive value and 44.7% diagnostic accuracy while RSBI threshold of 105 had 94.1% sensitivity, 43.6% specificity, 71.4% positive predictive value, 83.2% negative predictive value and 73.8% diagnostic accuracy. pO2/FiO2>250 had 76.9% sensitivity, 24.5% specificity, 60.4% positive predictive value, 41.5% negative predictive value and 55.9% diagnostic accuracy. Conclusion: Even though neither rapid shallow breathing nor the PFR was enough accurate in prediction of successful extubation but rapid shallow breathing index 105 threshold had higher sensitivity and specificity as compared to RSBI threshold 130PFR. Therefore, RSBI105 is more accurate in predicting the outcome of extubation of ICU patients. doi: https://doi.org/10.12669/pjms.35.6.788 How to cite this:Furqan A, Rai SA, Ali L, Ahmed RA. Comparing the predicted accuracy of PO2\FIO2 ratio with rapid shallow breathing index for successful spontaneous breathing trail in Intensive Care Unit. Pak J Med Sci. 2019;35(6):1605-1610. doi: https://doi.org/10.12669/pjms.35.6.788 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Time to blood, respiratory and urine culture positivity in the intensive care unit: Implications for de-escalation

SAGE Open Medicine ◽

10.1177/20503121211040702 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110407

Author(s):

Lindsey A Sellers ◽

Kathryn M Fitton ◽

Margaret F Segovia ◽

Christy C Forehand ◽

Kevin K Dobbin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Urine Culture ◽

Culture Collection ◽

Empiric Antibiotic Therapy ◽

Empiric Antibiotic ◽

Sensitivity Specificity

Objectives: Concern for late detection of bacterial pathogens is a barrier to early de-escalation efforts. The purpose of this study was to assess blood, respiratory and urine culture results at 72 h to test the hypothesis that early negative culture results have a clinically meaningful negative predictive value. Methods: We retrospectively reviewed all patients admitted to the medical intensive care unit between March 2012 and July 2018 with blood cultures obtained. Blood, respiratory and urine culture results were assessed for time to positivity, defined as the time between culture collection and preliminary species identification. The primary outcome was the negative predictive value of negative blood culture results at 72 h. Secondary outcomes included sensitivity, specificity, positive predictive value and negative predictive value of blood, respiratory and urine culture results. Results: The analysis included 1567 blood, 514 respiratory and 1059 urine cultures. Of the blood, respiratory and urine cultures ultimately positive, 90.3%, 76.2% and 90.4% were positive at 72 h. The negative predictive value of negative 72-h blood, respiratory and urine cultures were 0.99, 0.82 and 0.97, respectively. Antibiotic de-escalation had good specificity, positive predictive value and negative predictive value for finalized negative cultures. Conclusion: Negative blood and urine culture results at 72 h had a high negative predictive value. These findings have important ramifications for antimicrobial stewardship efforts and support protocolized re-evaluation of empiric antibiotic therapy at 72 h. Caution should be used in patients with clinically suspected pneumonia, since negative respiratory culture results at 72 h were weakly predictive of finalized negative cultures.

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Computed Tomography of the Chest in the Intensive Care Unit

Critical Care Clinics ◽

10.1016/s0749-0704(18)30128-3 ◽

1994 ◽

Vol 10 (2) ◽

pp. 267-275 ◽

Cited By ~ 11

Author(s):

Barry H. Gross ◽

David L. Spizarny

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care

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