The value of SEH scores during bronchoscopy in evaluating of ventilator-associated pneumonia in critical patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Yiyi ¹ , YANG Lan ¹ , LIANG Guopeng ¹ , ZHANG Yan ² , ZHOU Yongfang ¹ , DAI Haixia ¹ , LIU Yilin ¹ ,  WANG Bo ² ,  KANG Yan ^2,3

1. Department of Respiratory Care, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China;
2. Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China;
3. Department of Critical Care Medicine, West China Tianfu Hospital of Sichuan University, Chengdu, Sichuan, P.R. China;

Corresponding author：

WANG Bo, Email: kangyan_hx@163.com; KANG Yan, Email: wchicu@126.com

Keywords：

Ventilator-associated pneumonia; Bronchoscopy; Pulmonary infection; Mechanical ventilation; Prediction model

DOI：

10.7507/1671-6205.202501042

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Objective To observe the relationship between ventilator-associated pneumonia (VAP) and changes in bronchial mucosa and sputum in critically ill patients. A prediction model for SEH score was developed according to the abnormal degrees of airway sputum , mucosal edema and mucosal hyperemia , as well as to analyze the diagnostic value of the SEH scores for VAP during bronchoscopy. Methods A collection of general data and initial bronchoscopy results was conducted for patients admitted to the department of intensive care unit at West China Hospital from March 1, 2024, to July 1, 2024. Patients were divided into infection group (n=138) and non-infection group (n=227) according to diagnostic criteria for VAP based on the date of their first bronchoscopy. T-tests were used to compare baseline data between groups, while analysis of variance was employed to assess differences in airway mucosal and sputum lesions. A binary logistic regression model was constructed using the SEH scores for predicting VAP risk, with receiver operating characteristic curve area under the curve (AUC) utilized to evaluate model accuracy. Results A total of 365 patients were included in this study, among which 138 cases (37.8%) were diagnosed with VAP. The AUC for using SEH scores in diagnosing VAP was found to be 0.81 [95% confidence interval (CI) 0.76-0.85], with an optimal cutoff value set at 6.5. The sensitivity and specificity of SEH scores for diagnosing VAP were determined as 79.7% (95% CI: 72.2%-85.6%) and 73.1% (95% CI:67.0%-78.5%). Patients with SEH scores over 6.5 exhibited a significantly higher rate of VAP infection (64.3% vs.14.4%, P<0.0001), elevated white blood cell count levels (WBC) [(13.3±7.5 vs.1.8±6.2), P=0.04], as well as increased hospital mortality rates (39.8 % vs.24.2 %, P=0.002). Conclusions The SEH scores has a certain efficacy in the diagnosis of VAP in patients with mechanical ventilation. Compared with the traditional VAP diagnostic criteria, SEH scores is easier to obtain in clinical practice, and has certain clinical application value.

Citation： YANG Yiyi, YANG Lan, LIANG Guopeng, ZHANG Yan, ZHOU Yongfang, DAI Haixia, LIU Yilin, WANG Bo, KANG Yan. The value of SEH scores during bronchoscopy in evaluating of ventilator-associated pneumonia in critical patients. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(2): 107-114. doi: 10.7507/1671-6205.202501042 Copy

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2.	Reignier J, Mercier E, Le Gouge A, et al. Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA, 2013, 309(3): 249-256.
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11.	Martin-Loeches I, Povoa P, Rodríguez A, et al. TAVeM study. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med, 2015, 3(11): 859-868.
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15.	Ligen L, Hongming Y, Feng L, et al. Morphologic changes and prognosis of the respiratory tract epithelium in inhalation injury and their relationship with clinical manifestations. Surgery, 2012, 151(2): 206-212.
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18.	Chang AB, Faoagali J, Cox NC, et al. A bronchoscopic scoring system for airway secretions--airway cellularity and microbiological validation. Pediatr Pulmonol, 2006, 41(9): 887-892.
19.	Petrucci E, Cofini V, Pizzi B, et al. Hypopharynx, oropharynx morphology and histology in severe Coronavirus 2 patients treated by noninvasive ventilation: comparison between full-face mask and helmet strategies. Minerva Anestesiol, 2022, 88(11): 918-927.
20.	蒋红, 王树珍. 临床护理技术规范. 上海, 复旦大学出版社, 2006.
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22.	Chastre J, Luyt CE. Does this patient have VAP? Intensive Care Med, 2016, 42(7): 1159-1163.
23.	中华人民共和国国家卫生和计划生育委员会. 软式内镜清洗消毒技术规范: WS 507-2016. 2016.
24.	王广发, 黄珺君, 章巍. 成人诊断性可弯曲支气管镜检查术应用指南(2019年版). 中华结核和呼吸杂志, 2019, 42(8): 573-590.
25.	Niehues SM, Adams LC, Gaudin RA, et al. Deep-Learning-Based Diagnosis of Bedside Chest X-ray in Intensive Care and Emergency Medicine. Investigative Radiology, 2021, 56(8): 525-534.
26.	Eisenhuber E, Schaefer-Prokop CM, Prosch H, et al. Bedside chest radiography. Respir Care, 2012, 57(3): 427-443.
27.	Ippolito D, Pecorelli A, Maino C, et al. Diagnostic impact of bedside chest X-ray features of 2019 novel coronavirus in the routine admission at the emergency department: case series from Lombardy region. Eur J Radiol, 2020, 129: 109092.
28.	Self WH, Courtney DM, McNaughton CD, et al. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med, 2013, 31(2): 401-405.
29.	Murphy K. SARS CoV-2 Detection From Upper and Lower Respiratory Tract Specimens: Diagnostic and Infection Control Implications. Chest, 2020, 158(5): 1804-1805.

1. Koulenti D, Tsigou E, Rello J. Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study. Eur J Clin Microbiol Infect Dis, 2017, 36(11): 1999-2006.
2. Reignier J, Mercier E, Le Gouge A, et al. Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA, 2013, 309(3): 249-256.
3. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
4. Forel JM, Voillet F, Pulina D, et al. Papazian L. Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy. Crit Care, 2012, 16(2): R65.
5. Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013, 173(22): 2039-2046.
6. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med, 2020, 46(5): 888-906.
7. Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J, 2017, 50(3): 1700582.
8. 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版). 中华结核和呼吸杂志, 2018, 41(4): 255-280.
9. Kradin RL, Digumarthy S. The pathology of pulmonary bacterial infection. Semin Diagn Pathol, 2017, 34(6): 498-509.
10. Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
11. Martin-Loeches I, Povoa P, Rodríguez A, et al. TAVeM study. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med, 2015, 3(11): 859-868.
12. Klompas M. Complications of mechanical ventilation--the CDC's new surveillance paradigm. N Engl J Med. 2013, 368(16): 1472-1475.
13. Salluh JIF, Souza-Dantas VC, Martin-Loeches I, et al. Ventilator-associated tracheobronchitis: an update. Rev Bras Ter Intensiva, 2019, 31(4): 541-547.
14. 彭刚艺, 刘雪琴. 临床护理技术规范(基础篇), 第二版. 广州, 广东科技出版社, 2013.
15. Ligen L, Hongming Y, Feng L, et al. Morphologic changes and prognosis of the respiratory tract epithelium in inhalation injury and their relationship with clinical manifestations. Surgery, 2012, 151(2): 206-212.
16. Chen H, Yao Y, Wang S, et al. Selection of the access channel in bronchoscopic intervention. Expert Rev Respir Med, 2022, 16(6): 707-712.
17. Stockley RA, Bayley D, Hill SL, et al. Assessment of airway neutrophils by sputum colour: correlation with airways inflammation. Thorax, 2001, 56(5): 366-372.
18. Chang AB, Faoagali J, Cox NC, et al. A bronchoscopic scoring system for airway secretions--airway cellularity and microbiological validation. Pediatr Pulmonol, 2006, 41(9): 887-892.
19. Petrucci E, Cofini V, Pizzi B, et al. Hypopharynx, oropharynx morphology and histology in severe Coronavirus 2 patients treated by noninvasive ventilation: comparison between full-face mask and helmet strategies. Minerva Anestesiol, 2022, 88(11): 918-927.
20. 蒋红, 王树珍. 临床护理技术规范. 上海, 复旦大学出版社, 2006.
21. Leone M, Bouadma L, Bouhemad B, et al. Brief summary of French guidelines for the prevention, diagnosis and treatment of hospital-acquired pneumonia in ICU. Ann Intensive Care, 2018, 8(1): 104.
22. Chastre J, Luyt CE. Does this patient have VAP? Intensive Care Med, 2016, 42(7): 1159-1163.
23. 中华人民共和国国家卫生和计划生育委员会. 软式内镜清洗消毒技术规范: WS 507-2016. 2016.
24. 王广发, 黄珺君, 章巍. 成人诊断性可弯曲支气管镜检查术应用指南(2019年版). 中华结核和呼吸杂志, 2019, 42(8): 573-590.
25. Niehues SM, Adams LC, Gaudin RA, et al. Deep-Learning-Based Diagnosis of Bedside Chest X-ray in Intensive Care and Emergency Medicine. Investigative Radiology, 2021, 56(8): 525-534.
26. Eisenhuber E, Schaefer-Prokop CM, Prosch H, et al. Bedside chest radiography. Respir Care, 2012, 57(3): 427-443.
27. Ippolito D, Pecorelli A, Maino C, et al. Diagnostic impact of bedside chest X-ray features of 2019 novel coronavirus in the routine admission at the emergency department: case series from Lombardy region. Eur J Radiol, 2020, 129: 109092.
28. Self WH, Courtney DM, McNaughton CD, et al. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med, 2013, 31(2): 401-405.
29. Murphy K. SARS CoV-2 Detection From Upper and Lower Respiratory Tract Specimens: Diagnostic and Infection Control Implications. Chest, 2020, 158(5): 1804-1805.

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