High Dose Nebulized Amikacin: a Pilot Study in Ventilated Patients with Healthcare Associated Pneumonia

cytokines determination was used ELISA. RESULTS. 41 patients were included, 11 (26 %) developed VAP. APACHE II 24 ± 7. Development of VAP was associated with higher ICU stay, time under MV and mortality. Baseline Those who developed VAP presented worst pO2/FiO2 ratio 152 vs 259 (p \ 0.01). In 24 % of patients was identified a microorganism, (26 % of non-VAP patients and 18 % in VAP-patients, in which were multi-resistant). VAP-patients, showed significantly higher TNF-a blood levels 7.6 vs 5.5 pg/ml (p \ 0.05); MBAL TNF-a and IL-6 levels were lower 6.4 vs 19.6 pg/ml (p 0.08) and 5.4 vs 9.2 pg/ml (p 0.06) respectively. There were no differences with other cytokines or biomarkers.CPR or hs-CPR were not detectable in EBC. Follow-Up: VAP-patients: in three cases (27 %), causal microorganism was present in previous cultures. With regard to cytokines and biomarkers: blood TNF and MBAL IL-8 levels were significantly lower in samples previous to diagnosis of VAP (6.6 vs 7.7 pg/ml and 446 vs 2,460 pg/ml respectively). Those who developed VAP, at diagnosis, presented significant higher levels of: blood IL-8 and CRP; and MBAL, hs-CRP. PCT was also higher in blood and MBAL but not significantly. CONCLUSIONS. Only in 27 % of patients who developed VAP, precious cultures were helpful in diagnosis. We could not find a definite profile of any cytokine or biomarker that could anticipate diagnosis of VAP. Blood levels of IL-8 and CRP and MBAL levels of hsCRP and PCT are elevated in VAP patients. REFERENCE(S). 1. ATS, IDSA. Guidelines for the management of VAP. Am J Respir Crit Care Med. 2005. 2. Bayley DL. Validation of assays for inflammatory mediators in exhaled breath condensate. Eur Respir J. 2008. GRANT ACKNOWLEDGMENT. This study was sponsored by Pfizer.