title: Analysis of volatile organic compounds in exhaled breath to diagnose ventilator-associated pneumonia.
abstract: Ventilator-associated pneumonia (VAP) is a nosocomial infection occurring in the intensive care unit (ICU). The diagnostic standard is based on clinical criteria and bronchoalveolar lavage (BAL). Exhaled breath analysis is a promising non-invasive method for rapid diagnosis of diseases and contains volatile organic compounds (VOCs) that can differentiate diseased from healthy individuals. The aim of this study was to determine whether analysis of VOCs in exhaled breath can be used as a non-invasive monitoring tool for VAP. One hundred critically ill patients with clinical suspicion of VAP underwent BAL. Before BAL, exhaled air samples were collected and analysed by gas chromatography time-of-flight mass spectrometry (GC-tof-MS). The clinical suspicion of VAP was confirmed by BAL diagnostic criteria in 32 patients [VAP(+)] and rejected in 68 patients [VAP(-)]. Multivariate statistical comparison of VOC profiles between VAP(+) and VAP(-) revealed a subset of 12 VOCs that correctly discriminated between those two patient groups with a sensitivity and specificity of 75.8% ± 13.5% and 73.0% ± 11.8%, respectively. These results suggest that detection of VAP in ICU patients is possible by examining exhaled breath, enabling a simple, safe and non-invasive approach that could diminish diagnostic burden of VAP.
authors.affiliation: Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: Ronny
authors.initials: R
authors.lastname: Schnabel
authors.affiliation: Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: Fijten
authors.affiliation: Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Smolinska
authors.affiliation: Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Dallinga
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Boumans
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Stobberingh
authors.affiliation: Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: Boots
authors.affiliation: Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Roekaerts
authors.affiliation: Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: Dennis
authors.initials: D
authors.lastname: Bergmans
authors.affiliation: Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Frederik Jan
authors.initials: FJ
authors.lastname: van Schooten
mesh_terms: D001944:Breath Tests / Q000379:methods*; D015986:Confounding Factors, Epidemiologic; D045853:Exhalation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D025341:Principal Component Analysis; D012372:ROC Curve; D016896:Treatment Outcome; D055549:Volatile Organic Compounds / Q000032:analysis*
chemical_list: D055549:Volatile Organic Compounds